They considered NPWT in four indications: caesarean sections in obese women surgery for lower limb fracture knee/hip arthroplasty and coronary artery bypass graft surgery. Cost-effectiveness Five economic studies, based wholly or partially on trials included in our review, assessed the cost-effectiveness of NPWT compared with standard care. There is also moderate-certainty evidence for women undergoing caesarean sections (one trial, 876 participants) and people having surgery for lower limb fractures (one trial, 1549 participants) that there is probably little difference in quality of life scores at 30 days or 3 or 6 months, respectively. The overall effect of NPWT on pain is uncertain (very low-certainty evidence from seven trials (2218 participants) which reported disparate measures of pain) but moderate-certainty evidence suggests there is probably little difference between the groups in pain after three or six months following surgery for lower limb fracture (one trial, 1549 participants). The effect of NPWT on occurrence of haematoma or skin blisters is uncertain (very low-certainty evidence) for haematoma, the RR was 0.67 (95% CI 0.28 to 1.59 I 2 = 0% nine trials 1202 participants) and for blisters the RR was 2.64 (95% CI 0.65 to 10.68 I 2 = 69% seven trials 796 participants). For reoperation, the RR was 1.04 (95% CI 0.78 to 1.41 I 2 = 13% 12 trials 3523 participants) for seroma, the RR was 0.72 (95% CI 0.50 to 1.05 I 2 = 0% seven trials 729 participants). Secondary outcomes There is low-certainty evidence showing no clear difference between NPWT and standard treatment for the outcomes of reoperation and incidence of seroma. There is low-certainty evidence (downgraded once for risk of bias and once for imprecision) showing no clear difference in the risk of dehiscence after surgery for NPWT (5.3% of participants) compared with standard dressings (6.2% of participants) (RR 0.88, 95% CI 0.69 to 1.13 I 2 = 0%). Eighteen studies reported dehiscence 14 of these (3809 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 with standard dressings (13.0% of participants) after surgery RR 0.66 (95% CI 0.55 to 0.80 I 2 = 23%). Thirty-nine studies reported SSI 31 of these (6204 participants), were included in meta-analysis. 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 2 = 0%). Primary outcomes Four studies (2107 participants) reported mortality. Most studies had unclear or high risk of bias for at least one key domain. All studies compared NPWT with standard dressings. Economic studies assessed NPWT in orthopaedic, obstetric and general surgical settings. Studies evaluated NPWT in the context of a wide range of surgeries including orthopaedic, obstetric, vascular and general procedures. 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. 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. 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.Īt least two review authors independently assessed trials using predetermined inclusion criteria. There were no restrictions on language, publication date or study setting. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. 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. 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. Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs).
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