There may be a reduced risk of death after surgery for people treated with NPWT compared with standard dressings but there is uncertainty around this as confidence intervals include risk of benefit and harm (low‐certainty evidence). People with primary closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSIs than people treated with standard dressings but there is probably no difference in wound dehiscence (moderate‐certainty evidence). Other studies found low or very low‐certainty evidence indicating that NPWT may be cost‐effective for the indications assessed. There is moderate‐certainty evidence that NPWT in surgery for lower limb fracture was not cost‐effective at any threshold of willingness‐to‐pay and that NPWT is probably cost‐effective in obese women undergoing caesarean section. The reporting quality was good but the evidence certainty varied from moderate to very low. They calculated quality‐adjusted life‐years or an equivalent, and produced estimates of the treatments' relative cost‐effectiveness.
They considered NPWT in five indications: caesarean sections in obese women surgery for lower limb fracture knee/hip arthroplasty coronary artery bypass grafts and vascular surgery with inguinal incisions. Six economic studies, based wholly or partially on trials in our review, assessed the cost‐effectiveness of NPWT compared with standard care. Pain was measured in different ways and most studies could not be pooled this GRADE assessment is based on all fourteen trials reporting pain the pooled RR for the proportion of participants who experienced pain was 1.52 (95% CI 0.20, 11.31 I 2 = 34% two studies 632 participants). There is low‐certainty evidence of little to no difference in reported pain between groups. The effect of NPWT on haematoma is uncertain (RR 0.79 95 % CI 0.48 to 1.30 I 2 = 0% 17 trials 5909 participants very low‐certainty evidence).
#CONTRAINDICATIONS FOR NEGATIVE PRESSURE WOUND THERAPY SKIN#
For skin blisters, there is low‐certainty evidence that people treated with NPWT may be more likely to develop skin blisters compared with those treated with standard dressing (RR 3.55 95% CI 1.43 to 8.77 I 2 = 74% 11 trials 5015 participants). There may be a reduced risk of seroma for people treated with NPWT but this is imprecise: the RR was 0.82 (95% CI 0.65 to 1.05 I 2 = 0% 15 trials 5436 participants). There may be a reduced risk of reoperation favouring the standard dressing arm, but this was imprecise: RR 1.13 (95% CI 0.91 to 1.41 I 2 = 2% 18 trials 6272 participants). There is low‐certainty evidence for the outcomes of reoperation and seroma in each case, confidence intervals included both benefit and harm. 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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