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Comment & Response
April 3, 2019

Negative Pressure Wound Therapy for Surgical Site Infection Prevention Requires Further Study Before Widespread Adoption—Reply

Author Affiliations
  • 1Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
  • 2Royal College of Surgeons in Ireland, Dublin, Ireland
JAMA Surg. 2019;154(7):673-674. doi:10.1001/jamasurg.2019.0431

In Reply We thank Murphy et al for their interest in our recently published article1 demonstrating superiority of prophylactic negative pressure wound therapy (NPWT) over standard surgical dressings in closed laparotomy incisions performed in general and colorectal surgery. The objective of our study was to appraise all existing evidence surrounding the use of NPWT devices in patients undergoing closed laparotomy and takes place in a context where a number of randomized clinical trials (RCTs) are under way but have not yet been reported. To our knowledge, only 3 RCTs were available on the subject, with divergent results.2-4 However, there were 6 observational studies that examined this topic, and we took the view that combining all available data would provide the largest volume of evidence to address this important question. While collation of crude event rates from observational and randomized data may not directly reflect recommendations of the Cochrane organization, multiple previously published meta-analyses5,6 have adopted this methodology when RCTs are lacking. Moreover, we clearly define this methodology to enable readers to interpret our findings while also drawing attention to the high level of statistical heterogeneity associated with the included studies in the discussion. The strength of our review is reflected by its thorough search methodology and its systematic review component.

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