Negative pressure wound therapy for surgical wounds healing by primary closure

• Published in: Cochrane database of systematic reviews 2020-05, Vol.5 (5), p.CD009261
• Main Authors: Norman, Gill, Goh, En Lin, Dumville, Jo C, Shi, Chunhu, Liu, Zhenmi, Chiverton, Laura, Stankiewicz, Monica, Reid, Adam
• Format: Article
• Language: English
• Subjects: Bandages; Blister - epidemiology; Child health; Hematoma - epidemiology; Humans; Negative-Pressure Wound Therapy - economics; Negative-Pressure Wound Therapy - instrumentation; Negative-Pressure Wound Therapy - methods; Negative-Pressure Wound Therapy - mortality; Orthopedic Procedures; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Reoperation - statistics & numerical data; Seroma - epidemiology; Skin disorders; Skin Transplantation; Surgical Procedures, Operative - mortality; Surgical Wound - therapy; Surgical Wound Dehiscence - epidemiology; Surgical Wound Dehiscence - prevention & control; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; SURGICAL WOUNDS; Wound Healing; Wounds
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD009261.pub5

Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost-effectiveness of NPWT in wounds healing through primary closure. In June 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another type of NPWT. At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane 'Risk of bias' tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. In this third update, we added 15 new randomised controlled trials (RCTs) and three new economic studies, resulting in a total of 44 RCTs (7447 included participants) and five economic studies. Studies evaluated NPWT in the context of a wide range of surgeries including orthopaedic, obstetric, vascular and general procedures. Economic studies assessed NPWT in orthopaedic, obstetric and general surgical settings. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Four studies (2107 participants) reported mortality. There is low-certainty evidence (downgraded twice for imprecision) showing no clear difference in the risk of death after surgery for people treated with NPWT (2.3%) compared with standard dressings (2.7%) (risk ratio (RR) 0.86; 95% confidence interval (CI) 0.50 to 1.47; I = 0%). Thirty-nine studies reported SSI; 31 of these (6204 participants), were included in meta-analysis. There is moderate-certainty evidence (downgraded once for risk of bias) that NPWT probably results in fewer SSI (8.8% of participants) than treatment wit