Evidence was downgraded for imprecision, risk of bias, or a combination of these. There is moderate‐certainty evidence that there is probably little or no difference in dehiscence between people treated with NPWT (6.62%) and those treated with standard dressing (6.97%), although there is imprecision around the estimate that includes risk of benefit and harms RR 0.97 (95% CI 0.82 to 1.16 I 2 = 4%). Thirty studies reported wound dehiscence 23 studies (8724 participants) were pooled. There is moderate‐certainty evidence that NPWT probably results in fewer SSIs (8.7% of participants) than treatment with standard dressings (11.75%) after surgery RR 0.73 (95% CI 0.63 to 0.85 I 2 = 29%). Fifty‐four studies reported SSI 44 studies (11,403 participants) were pooled. There is low‐certainty evidence showing there may be a reduced risk of death after surgery for people treated with NPWT (0.84%) compared with standard dressings (1.17%) but there is uncertainty around this as confidence intervals include risk of benefits and harm risk ratio (RR) 0.78 (95% CI 0.47 to 1.30 I 2 = 0%). Most studies had unclear or high risk of bias for at least one key domain.Įleven studies (6384 participants) which reported mortality were pooled. All studies compared NPWT with standard dressings. Studies evaluated NPWT in a wide range of surgeries, including orthopaedic, obstetric, vascular and general procedures. In this fourth update, we added 18 new randomised controlled trials (RCTs) and one new economic study, resulting in a total of 62 RCTs (13,340 included participants) and six economic studies.
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