![]() Surgical site infections increase patient discomfort, length of hospital stay, and treatment costs. The incidence of SSI may be as high as 40% for some types of surgery, and may also be higher for people with medical problems such as diabetes or cancer. Surgical site infections are common wound infections that develop at the site of a surgical incision. We reviewed the evidence about the effectiveness of negative pressure wound therapy (NPWT) for preventing surgical site infection (SSI). Negative pressure wound therapy for surgical wounds healing by primary closure ![]() We rated the overall quality of the reports as very good we did not grade the evidence beyond this as it was based on modelling assumptions. A second cost‐effectiveness study estimated that when compared with standard dressings NPWT was cost saving and improved QALYs. One trial concluded that NPWT may be more cost‐effective than standard care, estimating an incremental cost‐effectiveness ratio (ICER) value of GBP 20.65 per QALY gained. There was no clear difference in incremental QALYs for NPWT relative to standard dressing when results from the two trials were combined (mean difference 0.00, 95% CI −0.00 to 0.00 moderate‐certainty evidence). ![]() Quality of life was not reported separately by group but was used in two economic evaluations to calculate quality‐adjusted life years (QALYs). It is uncertain if there is a higher risk of developing blisters when NPWT is compared with a standard dressing (RR 6.64, 95% CI 3.16 to 13.95 6 studies 597 participants very low‐certainty evidence, downgraded twice for very serious risk of bias and twice for very serious imprecision). It is uncertain if NPWT reduces or increases the risk of haematoma when compared with a standard dressing (RR 1.05, 95% CI 0.32 to 3.42 6 trials 831 participants very low‐certainty evidence, downgraded twice for very serious risk of bias and twice for very serious imprecision. It is also uncertain whether NPWT reduces incidence of seroma compared with standard dressings (RR 0.67, 95% CI 0.45 to 1.00 6 studies 568 participants very low‐certainty evidence, downgraded twice for very serious risk of bias and once for serious imprecision). We are uncertain whether NPWT increases or decreases reoperation rates when compared with a standard dressing (RR 1.09, 95% CI 0.73 to 1.63 6 trials 1021 participants very low‐certainty evidence, downgraded for very serious risk of bias and serious imprecision) or if there is any clinical benefit associated with NPWT for reducing wound‐related readmission to hospital within 30 days (RR 0.86, 95% CI 0.47 to 1.57 7 studies 1271 participants very low‐certainty evidence, downgraded for very serious risk of bias and serious imprecision). It is uncertain whether NPWT reduces the risk of wound dehiscence compared with standard dressings (RR 0.80, 95% CI 0.55 to 1.18 very low‐certainty evidence, downgraded twice for very serious risk of bias and once for serious imprecision). We combined results from 12 studies (1507 wounds 1475 participants follow‐up 30 days to an average of 113 days or unspecified) that compared NPWT with standard dressings. The evidence from 23 studies (2533 participants 2547 wounds follow‐up 30 days to 12 months or unspecified) showed that NPWT may reduce the rate of SSIs (RR 0.67, 95% CI 0.53 to 0.85 low‐certainty evidence, downgraded twice for very serious risk of bias).įourteen studies reported dehiscence. It is uncertain whether NPWT has an impact on risk of death compared with standard dressings (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.25 to 1.56 very low‐certainty evidence, downgraded once for serious risk of bias and twice for very serious imprecision). Three studies reported mortality (416 participants follow‐up 30 to 90 days or unspecified). We judged the evidence to be of low or very low certainty for all outcomes, downgrading the level of the evidence on the basis of risk of bias and imprecision. In three key domains four studies were at low risk of bias six studies were at high risk of bias and 20 studies were at unclear risk of bias. ![]() Surgeries included abdominal and colorectal (n = 5) caesarean section (n = 5) knee or hip arthroplasties (n = 5) groin surgery (n = 5) fractures (n = 5) laparotomy (n = 1) vascular surgery (n = 1) sternotomy (n = 1) breast reduction mammoplasty (n = 1) and mixed (n = 1). In this second update we added 25 intervention trials, resulting in a total of 30 intervention trials (2957 participants), and two economic studies nested in trials. ![]()
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