“The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. This study aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA).”

“Despite existing evidence on the effectiveness of iNPWT for the prevention of SSI, iNPWT is still not standard practice.This situation is possibly due to the ambiguity of recommendations from trials and guidelines, and the former paucity of subspecialty evidence on which surgeons usually focus. We provide an overview of all meta-analyses and their characteristics comparing the efficacy of iNPWT to standard dressings on the incidence of SSI and we conduct an up-to-date systematic review and meta-analysis including also the recent RTCs. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment shows high-certainty evidence that iNPWT is effective in reducing SSI in patients undergoing a surgical procedure of any wound classification. This result is substantiated in the sensitivity analyses of only studies with low risk of bias, and studies without funding or involvement of the industry. Compared with previous meta-analyses the RR stabilised and the confidence interval narrowed, indicating incremental certainty of the evidence. Newly, we performed a trial sequential analysis (TSA) to explore the additive value of new randomised controlled trials. The cumulative Z-curve crossed
the trial sequential monitoring boundary for benefit, indicating that future randomised controlled trials are unlikely to change the effect estimate for the outcome SSI.”

Groenen H, et al . Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis. EClinicalMedicine. 2023 Jul 24;62:102105. Free Full Text