Vacuum-Assisted Closure Therapy Outcomes According to Gender Composition: A Systematic Review and Meta-Analysis

Abstract

Background: VAC therapy success varies across study populations. We performed a meta-analysis to examine whether study-level gender composition was associated with differences in VAC therapy success.

Methods: Fifty-four studies (2,290 patients; 2,015 successful events) were included. Pooled success proportions were estimated using a random-effects model with REML estimation of between-study variance. Subgroup analysis was performed according to study-level gender composition, with sensitivity analyses to assess robustness.

Results: The pooled success rate was 88.63% (95% CI 85.7-91.3%), with substantial heterogeneity (Q = 188.31, I2 = 71.9%, tau2 = 0.0178). The primary subgroup analysis by gender composition was statistically significant (Q_between = 14.30, df = 2, p = 0.0010). However, the female-predominant stratum contained only one study (n = 30), and exclusion of this stratum reduced the subgroup difference to non-significance (Q_between = 0.85, df = 1, p = 0.36). Leave-one-out analysis of the overall pooled estimate ranged from 88.32% to 89.22%. Egger and Begg tests were non-significant (p = 0.9364 and p = 0.8048, respectively).

Conclusions: Study-level gender composition was associated with differences in pooled VAC therapy success in the primary subgroup analysis; however, this finding was not robust after exclusion of the single female-predominant study and should not be interpreted as evidence of an independent biological gender effect. Differences in wound characteristics and case mix may account for the observed subgroup pattern.