SBU:s upplysningstjänst
Publikation nr: ut202333
Publicerad: 7 november 2023
Nedladdad: 1 maj 2025
Val av postoperativa förband

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Val av postoperativa förband

Publicerad: 7 november 2023

Fråga och sammanfattning

En infektion i ett kirurgiskt sår kan innebära ökat lidande för patienten och ökade kostnader för sjukvården. Det förebyggande arbetet är viktigt för att minska andelen postoperativa sårinfektioner. Efter en operation appliceras ett sterilt förband för att bland annat skydda såret och främja sårläkning. Det finns många olika typer av förband, både med och utan så kallad undertrycksbehandling där en pump ansluten till förbandet drar vätska från operationssåret.

Fråga

Vilken sammanställd forskning finns om effekter på postoperativa sårinfektioner vid jämförelsen av olika förband?

Frågeställare: Universitetssjuksköterska, Region Stockholm

Sammanfattning

SBU:s upplysningstjänst har efter litteratursökning, relevansgranskning och bedömning av risk för bias redovisat två systematiska översikter i svaret. Författarna till en översikt fann att varken filmförband, hydrokolloidförband, hydrofiberförband eller silverförband hade någon effekt på förekomsten av postoperativ sårinfektion jämfört med en kontrollgrupp som fått ett standardförband. Översiktsförfattarna har bedömt att dessa resultat har mycket låg tillförlitlighet. Författarna till en annan översikt drog slutsatsen att förband med undertrycksbehandling jämfört med standardförband utan undertrycksbehandling kan bidra till minskade antal postoperativa sårinfektioner. Översiktsförfattarna har bedömt att dessa resultat har måttlig tillförlitlighet. Författarnas slutsatser har inte analyserats utifrån svenska förhållanden. Upplysningstjänsten har även identifierat 68 relevanta systematiska översikter som bedömts ha hög risk för bias. Författarnas slutsatser redovisas därför inte i svaret.

Att sammanvägda forskningsresultat saknas eller har mycket låg tillförlitlighet ska inte tolkas som att behandlingen/insatsen saknar effekt. Det betyder däremot att det behövs forskning för att förbättra kunskapsläget.

Bakgrund

Postoperativa sårinfektioner är den näst vanligaste typen av vårdrelaterade infektioner i Sverige och medför lidande för patienten. Eftersom postoperativa sårinfektioner har visat sig leda till ökad dödlighet, ökat antal återinläggningar, förlängda vårdtider samt ökade kostnader, är de också den typ av vårdrelaterade infektioner som kostar samhället mest [1]. Det är därför högst önskvärt att förhindra infektion i postoperativa sår.

Sår kan definieras som primärläkande eller sekundärläkande, där primärläkande sår direkt kan stängas medan sekundärläkande sår (även kallade svårläkta sår) kräver ytterligare åtgärder vid ett senare tillfälle innan läkning. Ett operationssår är i de flesta fallen ett primärläkande sår [2]. Sår kan även kategoriseras efter renhetsgrad. Rena sår innefattar sår med bakteriefri eller desinficerad vävnad. Potentiellt kontaminerade sår är till exempel sår efter komplikationsfri tarmkirurgi eller kirurgi i luft- eller urinvägar medan kontaminerade och smutsiga sår är sår efter intraoperativt tarmläckage, öppna benbrott eller andra traumatiska skador [3]. Till följd av bland annat detta har olika operationer olika inneboende risk för sårinfektioner.

Postoperativa sårinfektioner uppstår då bakterier infekterar ett nyligen opererat område. De kan variera i svårighetsgrad från mindre ytliga hudinfektioner till mer allvarliga och även livshotande infektioner av djupare strukturer eller implantat. Bakterier som orsakar postoperativa sårinfektioner kan dels komma från omgivningen, dels från patienten själv.

Ett postoperativt förband ska hålla ett operationssnitt torrt och rent under sårläkningsprocessen. I Sverige finns en klinisk praxis att låta ett sterilt applicerat operationsförband sitta i minst 48 timmar. Om förbandet av någon anledning tas bort inom 48 timmar rengörs såret och ett nytt sterilt förband appliceras med aseptisk teknik [4].

Det finns flera olika typer av förband. Olika förband kan variera i uppsugningsförmåga och ibland innehålla antiseptiska ämnen som silver eller antibiotika. Valet av förband behöver anpassas efter var såret sitter, hur mycket såret förväntas vätska och hur väl patientens hud tolererar förbandet. Förband med undertrycksbehandling (engelska: negative pressure wound therapy, NPWT) är en teknik där en pump kopplad till förbandet skapar ett undertryck och därmed suger vätska från sårområdet. Undertrycksbehandling användes från början till sekundärläkande eller infekterade sår men tekniken finns nu även för primärläkande sår (då ofta kallat ”incisional” eller ”prophylactic” NPWT).

Frågeställning och avgränsningar

Upplysningstjänsten har tillsammans med frågeställaren formulerat frågan enligt följande PICO1:

Population: Vuxna personer som genomgår kirurgi med primärläkande sår
Intervention: Förband
Control: Ett annat förband/standard care
Outcome: Postoperativ sårinfektion

Upplysningstjänsten har gjort sökningar (Bilaga 1) i databaserna Medline via Ovid, Scopus, Cinahl, samt i INAHTA2:s databas för HTA3-rapporter. Vi har även handsökt publikationer på webbsidor för regionala HTA-organisationer och myndigheter.

Svaret har begränsats till systematiska översikter.

Upplysningstjänsten inkluderar artiklar publicerade i vetenskapliga tidskrifter samt systematiska översikter och rapporter från myndigheter och HTA-organisationer, som är publicerade på engelska eller ett av de skandinaviska språken.

1. PICO är en förkortning för patient/population/problem, intervention (insats, behandling)/, comparison/control (jämförelseintervention (insats, behandling)) och outcome (utfallsmått).

2. International Network of Agencies for Health Technology Assessment (INAHTA).

3. Utvärdering av hälso- och sjukvårdens (och i SBU:s fall socialtjänstens) metoder (engelska: Health Technology Assessment).

Bedömning av risk för bias

I en systematisk översikt finns det risk för bias, det vill säga att resultatet blir snedvridet på grund av brister i avgränsning, litteratursökning och hantering av resultatet. Det är därför viktigt att granska metoden i en systematisk översikt. Två utredare bedömde risken för bias i översikterna med stöd av SBU:s granskningsmall för att översiktligt bedöma risken för snedvridning eller systematiska fel hos systematiska översikter (Bilaga 5). Granskningsmallen har sex steg och bygger på frågorna i AMSTAR granskningsmall [5]. Om översikten inte uppfyllde kraven listade i de tre första stegen bedömdes den ha hög risk för bias och granskades inte vidare. En systematisk översikt bedöms ha måttlig risk för bias om den uppfyller alla kraven till och med steg 4, och låg om den uppfyller samtliga steg i SBU:s mall (Bilaga 5 och Faktaruta 2).

Systematiska översikter med måttlig eller låg risk för bias beskrivs i text och tabell. De översikter som bedöms ha hög risk för bias presenteras inte i text och tabell eftersom risken för att resultaten är missvisande bedöms vara för hög.

Resultat från sökningen och bedömning av risk för bias

Upplysningstjänstens litteratursökning genererade totalt 1 063 artiklar efter dubblettkontroll. Ett flödesschema för urvalsprocessen visas i Bilaga 2. Två utredare på SBU läste alla artikelsammanfattningar och bedömde att 150 översikter kunde vara relevanta för frågan. Dessa artiklar lästes i fulltext av två utredare och 73 artiklar som inte var relevanta för frågan exkluderades. Exkluderade artiklar finns listade i Bilaga 3.

Två utredare på Upplysningstjänsten bedömde risken för bias i 77 systematiska översikter som var relevanta för frågan där nio av dessa bedömdes ha måttlig eller låg risk för bias och 68 bedömdes ha hög risk för bias [6–73]. I detta svar redovisas två av översikterna [74] [75] eftersom de är de mest heltäckande översikterna på området. De övriga sju översikterna [76–82] redovisas inte i detalj då de hade stort överlapp av inkluderade studier eller ett äldre publiceringsdatum. Upplysningstjänstens bedömning av risk för bias redovisas i Bilaga 4.

Systematiska översikter

SBU:s upplysningstjänst inkluderade två systematiska översikter med låg risk för bias i svaret (Tabell 1).

De båda översikterna inkluderade endast randomiserade kontrollerade studier. Den ena översikten inkluderade även ekonomiska analyser. Båda översikterna presenterar metodologiska svagheter i de inkluderade studierna, främst till följd av att interventionen inte blindats varken för forskare, vårdpersonal eller patient. De inkluderade studiernas metodologiska svagheter påverkar översiktsförfattarnas evidensgradering i båda översikterna. En översikt jämförde olika typer av förband utan undertrycksbehandling medan den andra fokuserade enbart på förband med undertrycksbehandling. Båda översikterna innehåller studier från flera världsdelar och inkluderade all typ av kirurgi. Båda översikterna inkluderade även patienter i alla åldrar, men gör ingen särredovisning vad gäller åldersgrupp.

Dumville och medarbetare jämförde olika förband med varandra med avseende på uppkomst av postoperativ sårinfektion [74]. I översikten skiljer man inte på djup eller ytlig sårinfektion. Översikten redovisar totalt elva jämförelser mellan sju olika typer av förband samt exponerat operationssår. Flera jämförelser består av endast en primärstudie och redovisas inte i detta svar. Av de elva jämförelserna bedömdes fyra vara relevanta för detta svar. De inkluderade totalt 18 randomiserade kontrollerade studier (RCT-studier) där filmförband, hydrokolloidförband, hydrofiberförband och silverförband jämfördes med kontrollförband. Ingen jämförelse visade att ett förband är bättre än kontrollförband vad gäller att förebygga uppkomst av postoperativ sårinfektion. Alla sammantagna resultat bedömdes ha mycket låg tillförlitlighet, då samtliga inkluderade studier utom en har stora metodologiska problem. De inkluderade studierna skilde sig åt vad gäller typ av kirurgiskt ingrepp, deltagarantal och förbandstyp i kontrollgrupperna och metaanalyserna bygger på få studier med låga deltagarantal.

Norman och medarbetare jämförde undertrycksförband med standardförband för postoperativa sår [75]. Författarna inkluderade 62 randomiserade kontrollerade studier (RCT-studier), varav endast 49 av dessa inkluderades i metaanalysen på grund av brister i rapportering eller metodologiska problem. Av dessa 49 studier utvärderade 44 studier uppkomsten av postoperativa sårinfektioner. De inkluderade studierna skilde sig med avseende på typ av kirurgiska ingrepp, deltagarantal, typ av undertrycksförband och förbandstyp i kontrollgruppen. Metaanalysen visade att undertrycksförband troligen minskade uppkomsten av postoperativa sårinfektioner jämfört med standardförband. Översiktsförfattarna bedömde att resultaten hade måttlig tillförlitlighet.

SBU har inte gjort någon syntes eller evidensgradering av resultaten. Det är möjligt att översiktsförfattarnas bedömning av de ingående primärstudierna och evidensgradering av resultaten kan avvika från de bedömningar som SBU skulle göra vid framtagandet av en systematisk översikt. Resultaten har inte analyserats utifrån svenska förhållanden.

Tabell 1 Systematiska översikter med låg risk för bias/Table 1 Systematic reviews with low risk of bias.
NPWT = negative pressure wound therapy; RCT = randomized controlled trial; RR = risk ratio; SSI = surgical site infection
Included studies Population, Intervention, Control Outcome and Results
Dumville et al, 2016 [74]
Dressings for the prevention of surgical site infection
Relevant studies:
18 RCT

Setting:
Europe:
10 studies
USA:
6 studies
Australia:
1 study
Japan:
1 study		 Population:
Studies involving adults or children (aged two years and over) who had undergone surgical procedures where healing of the surgical wound was planned by primary intention.

Intervention:Application of wound dressing

Control: Alternative dressings		 SSI:
Basic contact wound dressings vs film dressings
Clean surgery:
(4 studies, n=897)
RR 1.34 (95% CI, 0.70 to 2.55)
Very low certainty evidence

Basic contact wound dressings vs hydrocolloid dressings
Clean surgery:
(2 studies, n=556)
RR 0.91 (95% CI, 0.30 to 2.78)
Very low certainty evidence
Potentially contaminated surgery:
(3 studies, n=268)
RR 0.57 (95% CI, 0.22 to 1.51)
Very low certainty evidence

Basic wound contact dressings vs fibrous‐hydrocolloid (hydrofibre) dressings
Clean surgery:
(3 studies, n=364)
RR 1.29 (95% CI, 0.50 to 3.28)
Very low certainty evidence

Basic wound contact dressings vs silver dressings
Clean surgery:
(2 studies, n=496)
RR 1.11 (95% CI, 0.47 to 2.62)
Very low certainty evidence
Potentially contaminated surgery:
(5 studies, n=1353)
RR 0.83 (95% CI, 0.51 to 1.37)
Very low certainty evidence
Authors' conclusion:
”…there was insufficient evidence on which to base solid conclusions regarding whether any single type of dressing reduces risk of SSIs in wounds resulting from surgery”
Norman et al, 2022 [75]
Negative pressure wound therapy for surgical healing by primary closure
62 RCT6 economic studies

Setting:
North America:
28 studies
Europe:
24 studies
Australasia:
5 studies
Israel:
1 study
Japan:
1 study
South Korea:
1 study
Not reported:
2 studies		 Population:
Studies involving people of any age and in any care with uninfected surgical wounds healing by primary closure.

Surgical procedure:
Knee or hip arthroplasties: 8 studies
Peripheral vascular procedures: 10 studies
Caesarean section: 10 studies
Abdominal procedures: 14 studies
Limb fracture: 6 studies
Cardiac surgery: 3 studies
Hepatopancreatiobiliary procedures: 3 studies
Breast surgery: 3 studies
Mixed wound types: 2 studies
Hand injuries: 1 study
Inguinal lymph node dissection: 1 study
Spinal surgery: 1 study

Intervention:
NPWT for closed surgical incisions delivered by any mode.
Type of NPWT (brand)
VAC: 7 studies
PICO: 20 studies
PREVENA: 24 studies
CuraVac: 1 study
NANOVA: 1 study
Not specified: 9 studies

Control:
Standard dressing or advanced dressing		 SSI:
(Follow-up period 30 days to 12 months or unspecified)

NPWT vs standard dressing
Overall:
(44 studies, n=11 403)
RR 0.73 (95% CI, 0.63 to 0.85)
Moderate certainty evidence
⊕⊕⊕⊝
Superficial SSI:
(22 studies, n=5539)
RR 0.70 (95% CI, 0.53 to 0.92)
Deep SSI:
(22 studies, n=8521)
RR 0.95 (95% CI, 0.76 to 1.18)
Clean surgery:
(17 studies, n=2288)
RR 0.58 (95% CI, 0.41 to 0.81)
Clean-contaminated surgery:
(21 studies, n=7282)
RR 0.83 (95% CI, 0.72 to 0.96)  
Contaminated surgery:
(3 studies, n=1649)
RR (95% CI, 0.28 to 2.14)
Dirty surgery:
(3 studies, n=184)
RR 0.27 (95% CI, 0.06 to 1.12)
Authors' conclusion:
“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). Assessments of cost-effectiveness of NPWT produced differing results in different indications. There is a large number of ongoing studies, the results of which may change the findings of this review.”

SBU:s upplysningstjänst inkluderade 68 systematiska översikter med hög risk för bias [6-73]. Resultat och slutsatser presenteras inte i text och tabell eftersom risken för att resultaten är missvisande bedöms vara för hög.

Lästips

Norman och medarbetare inkluderade även sex kostnadseffektivitetsstudier i sin översikt [76]. Dessa studier tittade på personer med frakturer i underbenen, knä- och höftoperationer, hjärt-och kärlkirurgi samt överviktiga kvinnor som genomgått kejsarsnitt.

Vetenskapliga kunskapsluckor

Enligt SBU:s modell innebär en vetenskaplig kunskapslucka att det saknas evidens för vilken sammanvägd effekt en metod eller insats har, det vill säga kunskap från en systematisk översikt (Faktaruta 3).

SBU:s upplysningstjänst har efter litteratursökning identifierat två systematiska översikter med låg risk för bias. Resultaten räcker inte för att bedöma om risken för sårinfektion skiljer sig mellan olika sårförband. De visar därmed på en kunskapslucka för den jämförelsen. Ingen litteratursökning efter primärstudier har gjorts så nya primärstudier kan ha tillkommit efter att översikterna publicerades. För att besvara Upplysningstjänstens fråga behövs en välgjord och ny systematisk översikt som identifierar alla relevanta primärstudier och väger samman resultaten.

 

Projektgrupp

Detta svar är sammanställt av Lisa Andersson (utredare), Sally Saad (utredare), Sara Fundell (projektadministratör), Irene Edebert (produktsamordnare), Per Lytsy (intern sakkunnig), Anna Christensson (intern sakkunnig) samt Pernilla Östlund (avdelningschef) vid SBU.

Referenser

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  28. Hays TR, Singh G, Saragossi J, Park J, Shekar S, Marquez JE, et al. Negative-Pressure Wound Therapy versus Standard Surgical Dressings after Malignant Tumor Resection: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2022;150(3):655e-70e. Available from: https://doi.org/10.1097/PRS.0000000000009448.
  29. Hong J, Xie L, Fan L, Huang H. The wound adjuncts effect of closed incision negative pressure wound therapy on stopping groin surgical site wound infection in arterial surgery: A meta-analysis. Int Wound J. 2023;20(7):2726-34. Available from: https://doi.org/10.1111/iwj.14146.
  30. Huang HP, Zhao WJ, Pu J, He F. Prophylactic negative pressure wound therapy for surgical site infection in obese women undergoing cesarean section: an evidence synthesis with trial sequential analysis. J Matern Fetal Neonatal Med. 2021;34(15):2498-505. Available from: https://doi.org/10.1080/14767058.2019.1668924.
  31. Hyldig N, Birke-Sorensen H, Kruse M, Vinter C, Joergensen JS, Sorensen JA, et al. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg. 2016;103(5):477-86. Available from: https://doi.org/10.1002/bjs.10084.
  32. Ingargiola MJ, Daniali LN, Lee ES. Does the application of incisional negative pressure therapy to high-risk wounds prevent surgical site complications? A systematic review. Eplasty. 2013;13:e49.
  33. Jiang N, Rao F, Xiao J, Yang J, Wang W, Li Z, et al. Evaluation of different surgical dressings in reducing postoperative surgical site infection of a closed wound: A network meta-analysis. Int J Surg. 2020;82:24-9. Available from: https://doi.org/10.1016/j.ijsu.2020.07.066.
  34. Kim JH, Kim HJ, Lee DH. Comparison of the Efficacy Between Closed Incisional Negative-Pressure Wound Therapy and Conventional Wound Management After Total Hip and Knee Arthroplasties: A Systematic Review and Meta-Analysis. J Arthroplasty. 2019;34(11):2804-14. Available from: https://doi.org/10.1016/j.arth.2019.06.020.
  35. Kim JH, Lee DH. Are high-risk patient and revision arthroplasty effective indications for closed-incisional negative-pressure wound therapy after total hip or knee arthroplasty? A systematic review and meta-analysis. Int Wound J. 2020;17(5):1310-22. Available from: https://doi.org/10.1111/iwj.13393.
  36. Kuo FC, Hsu CW, Tan TL, Lin PY, Tu YK, Chen PC. Effectiveness of Different Wound Dressings in the Reduction of Blisters and Periprosthetic Joint Infection After Total Joint Arthroplasty: A Systematic Review and Network Meta-Analysis. J Arthroplasty. 2021;36(7):2612-29. Available from: https://doi.org/10.1016/j.arth.2021.02.047.
  37. Kuper TM, Murphy PB, Kaur B, Ott MC. Prophylactic Negative Pressure Wound Therapy for Closed Laparotomy Incisions: A Meta-analysis of Randomized Controlled Trials. Ann Surg. 2020;271(1):67-74. Available from: https://doi.org/10.1097/SLA.0000000000003435.
  38. Lambrechts MJ, D'Antonio ND, Issa TZ, Levy HA, Yalla GR, Berthiaume E, et al. The Usefulness of Closed Incision Negative Pressure Wound Therapy After Spinal Fusion: A Systematic Review and Meta-Analysis. World Neurosurg. 2022;168:258-67 e1. Available from: https://doi.org/10.1016/j.wneu.2022.09.048.
  39. Leach H. The efficacy of closed incision negative pressure wound therapy to reduce surgical site infections: a systematic review. Wounds International. 2021;12(2):34-40.
  40. Lenet T, Gilbert RWD, Abou-Khalil J, Balaa FK, Martel G, Brind'Amour A, et al. The impact of prophylactic negative pressure wound therapy on surgical site infections in pancreatic resection: A systematic review and meta-analysis. HPB (Oxford). 2022;24(12):2035-44. Available from: https://doi.org/10.1016/j.hpb.2022.08.010.
  41. Li HZ, Zhang L, Chen JX, Zheng Y, Zhu XN. Silver-containing dressing for surgical site infection in clean and clean-contaminated operations: a systematic review and meta-analysis of randomized controlled trials. J Surg Res. 2017;215:98-107. Available from: https://doi.org/10.1016/j.jss.2017.03.040.
  42. Li Y, Wu B, Liu Y. The Effect of Negative Pressure Therapy on Closed Wound After the Orthopedic Surgery of Lower Limb: A Meta-Analysis. Surg Innov. 2020;27(2):165-72. Available from: https://doi.org/10.1177/1553350619893222.
  43. Liew AN, Lim KY, Khoo JF. Closed Incision Negative Pressure Therapy vs Standard of Care Dressing in Breast Surgery: A Systematic Review. 2022;14(4):e24499. Available from: https://doi.org/10.7759/cureus.24499.
  44. Matar HE, Emms N, Raut V. Effectiveness of Negative-Pressure Wound Therapy following Total Hip and Knee Replacements. J Long Term Eff Med Implants. 2019;29(1):51-7. Available from: https://doi.org/10.1615/JLongTermEffMedImplants.2019030593.
  45. Meyer J, Roos E, Abbassi Z, Buchs NC, Ris F, Toso C. Prophylactic Negative-pressure Wound Therapy Prevents Surgical Site Infection in Abdominal Surgery: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies. Clin Infect Dis. 2021;73(11):e3804-e13. Available from: https://doi.org/10.1093/cid/ciaa1203.
  46. Nelson RL, Iqbal NM, Kravets A, Khateeb R, Raza M, Siddiqui M, et al. Topical antimicrobial prophylaxis in colorectal surgery for the prevention of surgical wound infection: a systematic review and meta-analysis. Tech Coloproctol. 2018;22(8):573-87. Available from: https://doi.org/10.1007/s10151-018-1814-1.
  47. Ren B, Jiang X, Chen J, Mo J. The efficacy of negative pressure wound therapy after hepatopancreatobiliary surgery: A systematic review and meta-analysis. Pak J Med Sci. 2022;38(8):2356-64. Available from: https://doi.org/10.12669/pjms.38.8.6601.
  48. Sahebally SM, McKevitt K, Stephens I, Fitzpatrick F, Deasy J, Burke JP, et al. Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery: A Systematic Review and Meta-analysis. JAMA Surg. 2018;153(11):e183467. Available from: https://doi.org/10.1001/jamasurg.2018.3467.
  49. Saunders C, Nherera LM, Horner A, Trueman P. Single-use negative-pressure wound therapy versus conventional dressings for closed surgical incisions: systematic literature review and meta-analysis. BJS Open. 2021;5(1). Available from: https://doi.org/10.1093/bjsopen/zraa003.
  50. Semsarzadeh NN, Tadisina KK, Maddox J, Chopra K, Singh DP. Closed Incision Negative-Pressure Therapy Is Associated with Decreased Surgical-Site Infections: A Meta-Analysis. Plast Reconstr Surg. 2015;136(3):592-602. Available from: https://doi.org/10.1097/PRS.0000000000001519.
  51. Sexton F, Healy D, Keelan S, Alazzawi M, Naughton P. A systematic review and meta-analysis comparing the effectiveness of negative-pressure wound therapy to standard therapy in the prevention of complications after vascular surgery. Int J Surg. 2020;76:94-100. Available from: https://doi.org/10.1016/j.ijsu.2020.02.037.
  52. Shiroky J, Lillie E, Muaddi H, Sevigny M, Choi WJ, Karanicolas PJ. The impact of negative pressure wound therapy for closed surgical incisions on surgical site infection: A systematic review and meta-analysis. 2020;167(6):1001-9. Available from: https://dTioi.org/10.1016/j.surg.2020.01.018.
  53. Singh DP, Gabriel A, Parvizi J, Gardner MJ, D'Agostino R, Jr. Meta-Analysis of Comparative Trials Evaluating a Single-Use Closed-Incision Negative-Pressure Therapy System. Plast Reconstr Surg. 2019;143(1S Management of Surgical Incisions Utilizing Closed-Incision Negative-Pressure Therapy):41S-6S. Available from: https://doi.org/10.1097/PRS.0000000000005312.
  54. Singh DP, Gabriel A, Silverman RP, Griffin LP, McGowan LD, D'Agostino RB, Jr. Meta-analysis Comparing Outcomes of Two Different Negative Pressure Therapy Systems in Closed Incision Management. Plast Reconstr Surg Glob Open. 2019;7(6):e2259. Available from: https://doi.org/10.1097/GOX.0000000000002259.
  55. Smid MC, Dotters-Katz SK, Grace M, Wright ST, Villers MS, Hardy-Fairbanks A, et al. Prophylactic Negative Pressure Wound Therapy for Obese Women After Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol. 2017;130(5):969-78. Available from: https://doi.org/10.1097/AOG.0000000000002259.
  56. Smolle MA, Nischwitz SP, Hutan M, Trunk P, Lumenta D, Bernhardt GA. Closed-incision negative-pressure wound management in surgery—literature review and recommendations. European Surgery. 2020;52(6):249-67. Available from: https://doi.org/10.1007/s10353-020-00657-w.
  57. Song J, Liu X, Wu T. Effectiveness of prophylactic application of negative pressure wound therapy in stopping surgical site wound problems for closed incisions in breast cancer surgery: A meta-analysis. Int Wound J. 2023;20(2):241-50. Available from: https://doi.org/10.1111/iwj.13866.
  58. Strugala V, Martin R. Meta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications. Surg Infect (Larchmt). 2017;18(7):810-9. Available from: https://doi.org/10.1089/sur.2017.156.
  59. Sun W, Chen M, Duan D, Liu W, Cui W, Li L. Effectiveness of moist dressings in wound healing after surgical suturing: A Bayesian network meta-analysis of randomised controlled trials. Int Wound J. 2023;20(1):69-78. Available from: https://doi.org/10.1111/iwj.13839.
  60. Swanson EW, Cheng H-T, Susarla SM, Lough DM, Kumar AR. Does negative pressure wound therapy applied to closed incisions following ventral hernia repair prevent wound complications and hernia recurrence? A systematic review and meta-analysis. Plast Surg (Oakv). 2016;24(2):113-8.
  61. Tian Y, Li K, Zeng L. A systematic review with meta-analysis on prophylactic negative pressure wound therapy versus standard dressing for obese women after caesarean section. Nurs Open. 2023;10(9):5999-6013. Available from: https://doi.org/10.1002/nop2.1912.
  62. Tran BNN, Johnson AR, Shen C, Lee BT, Lee ES. Closed-Incision Negative-Pressure Therapy Efficacy in Abdominal Wall Reconstruction in High-Risk Patients: A Meta-analysis. J Surg Res. 2019;241:63-71. Available from: https://doi.org/10.1016/j.jss.2019.03.033.
  63. Wang C, Zhang Y, Qu H. Negative pressure wound therapy for closed incisions in orthopedic trauma surgery: a meta-analysis. J Orthop Surg Res. 2019;14(1):427. Available from: https://doi.org/10.1186/s13018-019-1488-z.
  64. Wells CI, Ratnayake CBB, Perrin J, Pandanaboyana S. Prophylactic Negative Pressure Wound Therapy in Closed Abdominal Incisions: A Meta-analysis of Randomised Controlled Trials. World J Surg. 2019;43(11):2779-88. Available from: https://doi.org/10.1007/s00268-019-05116-6.
  65. Wijetunge S, Hill R, Katie Morris R, Hodgetts Morton V. Advanced dressings for the prevention of surgical site infection in women post-caesarean section: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;267:226-33. Available from: https://doi.org/10.1016/j.ejogrb.2021.11.014.
  66. Xie R, Li B, Wen F. Effect of prophylactic negative pressure treatment for post-surgery groin wounds management in vascular surgery: A meta-analysis. Int Wound J. 2023;20(2):269-77. Available from: https://doi.org/10.1111/iwj.13870.
  67. Xie W, Dai L, Qi Y, Jiang X. Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta-analysis. Int Wound J. 2022;19(6):1319-28. Available from: https://doi.org/10.1111/iwj.13726.
  68. Yaghmour KM, Hossain FS, Konan S. Clinical and Health-Care Cost Analysis of Negative Pressure Dressing in Primary and RevisionTotal Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am. 2020;Publish Ahead of Print:541-8. Available from: https://doi.org/10.2106/JBJS.20.01254.
  69. Yu L, Kronen RJ, Simon LE, Stoll CRT, Colditz GA, Tuuli MG. Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis. Am J Obstet Gynecol. 2018;218(2):200-10 e1. Available from: https://doi.org/10.1016/j.ajog.2017.09.017.
  70. Yuan S, Zhang T, Zhang D, He Q, Du M, Zeng F. Impact of negative pressure wound treatment on incidence of surgical site infection in varied orthopedic surgeries: A systematic review and meta-analysis. Int Wound J. 2023;20(6):2334-45. Available from: https://doi.org/10.1111/iwj.14043.
  71. Zhang D, He L. A systemic review and a meta-analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings. Int Wound J. 2023;20(1):46-54. Available from: https://doi.org/10.1111/iwj.13835.
  72. Zhu J, Sun Q, Xu W, Geng J, Feng Q, Zhao Z, et al. Effect of Negative Pressure Wound Therapy on Surgical Site Infections following Stoma Reversal in Colorectal Surgery: A Meta-Analysis. J Invest Surg. 2023:2175079. Available from: https://doi.org/10.1080/08941939.2023.2175079.
  73. Zhu Y, Dai L, Luo B, Zhang L. Meta-analysis of prophylactic negative pressure wound therapy for surgical site infections (SSI) in caesarean section surgery. Wideochir Inne Tech Maloinwazyjne. 2023;18(2):224-34. Available from: https://doi.org/10.5114/wiitm.2023.125913.
  74. Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, et al. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev. 2016;12(12):CD003091. Available from: https://doi.org/10.1002/14651858.CD003091.pub4.
  75. Norman G, Shi C, Goh EL, Murphy EM, Reid A, Chiverton L, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2022;4(4):CD009261. Available from: https://doi.org/10.1002/14651858.CD009261.pub7.
  76. Gillespie BM, Thalib L, Ellwood D, Kang E, Mahomed K, Kumar S, et al. Effect of negative-pressure wound therapy on wound complications in obese women after caesarean birth: a systematic review and meta-analysis. 2022;129(2):196-207. Available from: https://doi.org/10.1111/1471-0528.16963.
  77. Kirkham AM, Candeliere J, McIsaac DI, Stelfox HT, Dubois L, Gill HL, et al. Efficacy of Strategies Intended to Prevent Surgical Site Infection After Lower Limb Revascularization Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Surg. 2023;278(3):e447-e56. Available from: https://doi.org/10.1097/SLA.0000000000005867.
  78. Meyer J, Roos E, Davies RJ, Buchs NC, Ris F, Toso C. Does Prophylactic Negative-Pressure Wound Therapy Prevent Surgical Site Infection After Laparotomy? A Systematic Review and Meta-analysis of Randomized Controlled trials. World J Surg. 2023;47(6):1464-74. Available from: https://doi.org/10.1007/s00268-023-06908-7.
  79. Sandy-Hodgetts K, Watts R. Effectiveness of negative pressure wound therapy/closed incision management in the prevention of post-surgical wound complications: a systematic review and meta-analysis. JBI Database System Rev Implement Rep. 2015;13(1):253-303. Available from: https://doi.org/10.11124/jbisrir-2015-1687.
  80. Svensson-Bjork R, Zarrouk M, Asciutto G, Hasselmann J, Acosta S. Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery. Br J Surg. 2019;106(4):310-8. Available from: https://doi.org/10.1002/bjs.11100.
  81. Wee IJY, Syn N, Choong A. Closed Incision Negative Pressure Wound Therapy in Vascular Surgery: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2019;58(3):446-54. Available from: https://doi.org/10.1016/j.ejvs.2018.12.021.
  82. Zwanenburg PR, Tol BT, Obdeijn MC, Lapid O, Gans SL, Boermeester MA. Meta-analysis, Meta-regression, and GRADE Assessment of Randomized and Nonrandomized Studies of Incisional Negative Pressure Wound Therapy Versus Control Dressings for the Prevention of Postoperative Wound Complications. Ann Surg. 2020;272(1):81-91. Available from: https://doi.org/10.1097/SLA.0000000000003644.

Bilaga 1 Dokumentation av sökstrategier.

Medline via OvidSP 20 July 23

Title: Postoperative dressings
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase

a. Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity- and precision-maximizing version (2008 revision); Ovid format. The Cochrane Collaboration; 2008. Available from: https://training.cochrane.org/handbook/current/chapter-04-technical-supplement-searching-and-selecting-studies#section-3-6-1. with modifications: the following terms are added: clinical trial, phase iii.pt. ; randomised.ab. ; ("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.
Search terms Items found
Population:
1. exp Surgical Wound/ or ((exp Surgical Procedures, Operative/ or exp Perioperative Period/ or exp Perioperative Care/ or surger*.ti,ab,bt,kw. or surgical*.ti,ab,bt,kw. or operation*.ti,ab,bt,kw. or operative*.ti,ab,bt,kw. or perioperati*.ti,ab,bt,kw. or extracti*.ti,ab,bt,kw. or restorati*.ti,ab,bt,kw.) and (wound* or incisi* or excisi*).ti,ab,bt,kw.) 271 698
Intervention:
2. exp Bandages/ or dressing*.ti,ab,bt,kw. or bandage*.ti,ab,bt,kw. or “Negative Pressure”.ti,ab,bt,kw or “Vacuum Assisted”.ti,ab,bt,kw or NWPT.ti,ab,bt,kw or exp Negative-Pressure Wound Therapy/ 64 362
Study types: systematic reviews and meta-analysis / randomized controlled trialsa
3. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) 439 505
Combined sets:
4. 1 AND 2 12 813
5. 3 AND 4 570
Final result
6. 5 570

Scopus via scopus.com 20 July 23

Title: Postoperative dressings
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other.; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words.; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range.; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TITLE-ABS-KEY ( "Surgical wound*" ) OR ( TITLE-ABS-KEY ( "Surgical procedure*" OR "Perioperative period*" OR "perioperative car*" OR surger* OR surgical* OR operation* OR operative* OR perioperati* OR extracti* OR restorati* ) AND TITLE-ABS-KEY ( wound* OR incisi* OR excisi* ) ) 477 990
Intervention:
2. TITLE-ABS-KEY ( bandage* OR dressing* OR "negative pressure" OR "vacuum assisted" OR nwpt ) 120 887
Study types: systematic reviews and meta-analysis / randomized controlled trials
3. TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) 642 079
Combined sets:
4. 1 AND 2 20 028
5. 3 AND 4 790
Final result
6. 5 790

CINAHL via EBSCO 20 July 23

Title: Postoperative dressings
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); MH = Exact subject heading, indexed keywords; TX = All text; PT = Publication type; Nn = Near. Proximity operator retrieving terms within n words from each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase

b. Glanville J, Dooley G, Wisniewski S, Foxlee R, Noel-Storr A. Development of a search filter to identify reports of controlled clinical trials within CINAHL Plus. Health Info Libr J. 2019;36(1):73-90. Available from: https://doi.org/10.1111/hir.12251.
Search terms Items found
Population:
1. (MH Surgical Wound) or (MH Surgical Wound Care+) or (MH Perioperative Nursing+) or (((TI surg* or AB surg*) or (TI operat* or AB operat*)) and ((TI wound* or AB wound*) or (TI incisi* or AB incis*) or (TI excisi* or AB excisi*))) 57 795
Intervention:
2. (MH "Negative Pressure Wound Therapy") or (MH “Bandages and Dressings”+) or (TI bandage* or AB bandage* or “Negative Pressure” or “Vacuum Assisted” or NWPT) or (TI dressing* or AB dressing* or “Negative Pressure” or “Vacuum Assisted” or NWPT) 18 397
Study types: systematic reviews and meta-analysis / randomized controlled trialsb
3. ((TI((systematic N3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic N3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic N3 review) OR "meta analys*" OR metaanalys*)) OR (PT "Systematic Review" OR PT "meta analysis")) NOT (MH "Case Studies" OR PT "Commentary" OR PT "Editorial" OR PT "Letter") 239 209
Combined sets:
4. 1 AND 2 3352
5. 3 AND 4 228
Final result
6. 5 228

Citation Search

Scopus via Elsevier (citation search) 29 September 2023

Title: Postoperative dressings
LIMIT-TO (SRCTYPE, "j" = Limit to source type journal;
LIMIT-TO (DOCTYPE, "ar" = Limit to document type article;
LIMIT-TO (DOCTYPE, "re" = Limit to document type review
LIMIT-TO (PUBYEAR, X = Limit to publication year
Search terms Items found
Cited articles
1. DOI("10.1002/14651858.cd009261.pub7") 29
2. DOI("10.1002/14651858.CD003091.pub4") 32
Citing articles
3. #1 View cited by  

Bilaga 2 Flödesschema för urval av artiklar.

Av 1 063 granskade abstrakt lästes 150 i fulltext varav 77 inkluderades. Nio systematiska översikter hade låg till måttlig risk för bias och 68 hög risk för bias.

Bilaga 3 Exkluderade artiklar

Artiklar som exkluderats efter fulltextläsning på grund av bristande relevans

Excluded articles Reason for exclusion
Systematic reviews  
Aijia Y, Wenjie L, Junli Z, Chun L. Systematic evaluation of six dressings on wound safety following total hip and knee arthroplasty. Chin J Tissue Eng Res. 2023;27(3):486-92. Available from: https://doi.org/10.12307/2023.029. Foreign language
Ali E, Raghuvanshi M. Treatment of open upper limb injuries with infection prevention and negative pressure wound therapy: a systematic review. J Wound Care. 2017;26(12):712-9. Available from: https://doi.org/10.12968/jowc.2017.26.12.712. Wrong population
Andrew Glennie R, Dea N, Street JT. Dressings and drains in posterior spine surgery and their effect on wound complications. J Clin Neurosci. 2015;22(7):1081-7. Available from: https://doi.org/10.1016/j.jocn.2015.01.009. Wrong publication type
Atkinson RA, Ousey KJ, Lui S, Williamson JB. A Review of Evidence for Negative Pressure Wound Therapy (NPWT) use Post Spinal Surgery. EWMA Journal. 2013;13(1):24-5. Wrong publication type
Cahill C, Fowler A, Williams LJ. The application of incisional negative pressure wound therapy for perineal wounds: A systematic review. Int Wound J. 2018;15(5):740-8. Available from: https://doi.org/10.1111/iwj.12921. Wrong publication type
Carolina Giordani S, Maria da Graça Oliveira C. Dressings for the treatment of abdominal surgical wounds: a systematic review. Revista Gaucha de Enfermagem. 2012;33(3):182-9. Foreign language
Chaby G, Senet P, Vaneau M, Martel P, Guillaume JC, Meaume S, et al. Dressings for acute and chronic wounds: a systematic review. Arch Dermatol. 2007;143(10):1297-304. Available from: https://doi.org/10.1001/archderm.143.10.1297. Wrong population
Chicco M, Huang TC, Cheng HT. Negative-Pressure Wound Therapy in the Prevention and Management of Complications From Prosthetic Breast Reconstruction: A Systematic Review and Meta-analysis. Ann Plast Surg. 2021;87(4):478-83. Available from: https://doi.org/10.1097/SAP.0000000000002722. Wrong outcome
Chopra K, Gowda AU, Morrow C, Holton L, 3rd, Singh DP. The Economic Impact of Closed-Incision Negative-Pressure Therapy in High-Risk Abdominal Incisions: A Cost-Utility Analysis. Plast Reconstr Surg. 2016;137(4):1284-9. Available from: https://doi.org/10.1097/PRS.0000000000002024. Wrong study design
Collins A. Does the postoperative dressing regime affect wound healing after hip or knee arthroplasty? J Wound Care. 2011;20(1):11-6. Available from: https://doi.org/10.12968/jowc.2011.20.1.11. Wrong publication type
Costa ML, Achten J, Knight R, Png ME, Bruce J, Dutton S, et al. Negative-pressure wound therapy compared with standard dressings following surgical treatment of major trauma to the lower limb: the WHiST RCT. Health Technol Assess. 2020;24(38):1-86. Available from: https://doi.org/10.3310/hta24380. Wrong publication type
Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev. 2014(9):CD003091. Available from: https://doi.org/10.1002/14651858.CD003091.pub3. Newer update published
Dumville JC, Walter CJ, Sharp CA, Page T. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev. 2011(7):CD003091. Available from: https://doi.org/10.1002/14651858.CD003091.pub2. Newer update published
ElHawary H, Hintermayer MA, Alam P, Brunetti VC, Janis JE. Decreasing Surgical Site Infections in Plastic Surgery: A Systematic Review and Meta-analysis of Level 1 Evidence. Aesthet Surg J. 2021;41(7):NP948-NP58. Available from: https://doi.org/10.1093/asj/sjab119. Wrong population
Fan CW, Chen PH, Jhou HJ, Cheng YC. Negative pressure wound management in perineal wound status post abdominoperineal resection and extralevator abdominoperineal excision: a meta-analysis and trial sequential analysis. Int J Colorectal Dis. 2023;38(1):73. Available from: https://doi.org/10.1007/s00384-023-04353-5. Wrong control
Frantz CV, Stocco JGD, Ribeiro ACG, Vieira ALG. Dressings Indicated in the Treatment of Mediastinitis after Cardiac Surgery: Integrative Review. Texto & Contexto - Enfermagem. 2019;28:1-16. Available from: https://doi.org/10.1590/1980-265x-tce-2018-0073. Wrong outcome
Frodl A, Geisteuer N, Fuchs A, Nymark T, Schmal H. Incisional negative pressure wound therapy to reduce surgical-site infections in major limb amputations: a meta-analysis. EFORT Open Rev. 2022;7(8):526-32. Available from: https://doi.org/10.1530/EOR-22-0049. Wrong publication type
Gabriel A, Camardo M, O'Rorke E, Gold R, Kim PJ. Effects of Negative-Pressure Wound Therapy With Instillation versus Standard of Care in Multiple Wound Types: Systematic Literature Review and Meta-Analysis. Plast Reconstr Surg. 2021;147(1S-1):68S-76S. Available from: https://doi.org/10.1097/PRS.0000000000007614. Wrong population
Gallo L, Gallo M, Chin B, Copeland A, Avram R, McRae M, et al. Closed Incision Negative Pressure Therapy Versus Traditional Dressings for Low Transverse Abdominal Incisions Healing by Primary Closure: A Systematic Review and Meta-Analysis. Plastic Surg. 2022;31(4):390-400. Available from: https://doi.org/10.1177/22925503211073840. Wrong outcome
Gao J, Wang Y, Song J, Li Z, Ren J, Wang P. Negative pressure wound therapy for surgical site infections: A systematic review and meta-analysis. J Adv Nurs. 2021;77(10):3980-90. Available from: https://doi.org/10.1111/jan.14876. Wrong population
Gao Wb, Zhang Yr, Zhang J. Collagen/chitosan hemostatic dressings in surgical wounds. Chin J Tissue Eng Res. 2012;16(29):5477-80. Available from: https://doi.org/10.3969/j.issn.2095-4344.2012.29.032. Foreign language
Gillespie B. Negative pressure wound therapy for postoperative caesarean section wound complications. InScope. 2022(21):42. Wrong publication type
Gologorsky R, Arora S, Dua A. Negative-Pressure Wound Therapy to Reduce Wound Complications after Abdominoperineal Resection. Perm J. 2020;24. Available from: https://doi.org/10.7812/TPP/19.173. Wrong inclusion criteria
Grant-Freemantle MC, Ryan EJ, Flynn SO, Moloney DP, Kelly MA, Coveney EI, et al. The Effectiveness of Negative Pressure Wound Therapy Versus Conventional Dressing in the Treatment of Open Fractures: A Systematic Review and Meta-Analysis. J Orthop Trauma. 2020;34(5):223-30. Available from: https://doi.org/10.1097/BOT.0000000000001750. Wrong population
Gwilym BL, Dovell G, Dattani N, Ambler GK, Shalhoub J, Forsythe RO, et al. Editor's Choice - Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery. Eur J Vasc Endovasc Surg. 2021;61(4):636-46. Available from: https://doi.org/10.1016/j.ejvs.2020.11.053. Wrong intervention
Haidari S, FFA IJ, Metsemakers WJ, Maarse W, Vogely HC, Ramsden AJ, et al. The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection: A Systematic Review and Critical Appraisal. Biomed Res Int. 2021;2021:7742227. Available from: https://doi.org/10.1155/2021/7742227. Wrong population
Jensen NM, Steenstrup S, Ravn C, Schmal H, Viberg B. The use of negative pressure wound therapy for fracture-related infections following internal osteosynthesis of the extremity: A systematic review. J Clin Orthop Trauma. 2022;24:101710. Available from: https://doi.org/10.1016/j.jcot.2021.101710. Wrong population
Khan QI, Baig H, Al Failakawi A, Majeed S, Khan M, Lucocq J. The Effect of Platelet-Rich Plasma on Healing Time in Patients Following Pilonidal Sinus Surgery: A Systematic Review. Cureus. 2022;14(8):e27777. Available from: https://doi.org/10.7759/cureus.27777. Wrong population
Kim JH, Lee DH. Negative pressure wound therapy vs. conventional management in open tibia fractures: Systematic review and meta-analysis. Injury. 2019;50(10):1764-72. Available from: https://doi.org/10.1016/j.injury.2019.04.018. Wrong population
Lakhani A, Jamel W, Riddiough GE, Cabalag CS, Stevens S, Liu DS. Prophylactic negative pressure wound dressings reduces wound complications following emergency laparotomies: A systematic review and meta-analysis. Surgery. 2022;172(3):949-54. Available from: https://doi.org/10.1016/j.surg.2022.05.020. Wrong population
Li HZ, Xu XH, Wang DW, Lin YM, Lin N, Lu HD. Negative pressure wound therapy for surgical site infections: a systematic review and meta-analysis of randomized controlled trials. Clin Microbiol Infect. 2019;25(11):1328-38. Available from: https://doi.org/10.1016/j.cmi.2019.06.005. Wrong population
Li P, Li J. Effect of incisional negative pressure therapy and conventional treatment on wound complications after orthopaedic trauma surgery: A meta-analysis of randomized controlled studies. Int Wound J. 2023. Available from: https://doi.org/10.1111/iwj.14331. Wrong outcome
Li Y, Shuai M. Modified Robert Jones Bandage in reducing blood loss in total knee arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2021;100(37):e27156. Available from: https://doi.org/10.1097/MD.0000000000027156. Wrong outcome
Lin FY, Kempny T, Knoz M, Cheng HT. Meta-analysis of randomized controlled studies of closed incisional negative pressure wound therapy versus standard wound dressing in the prevention of surgical site infections for patients undergoing surgeries for lower extremity fractures. J Plast Reconstr Aesthet Surg. 2023;79:68-73. Available from: https://doi.org/10.1016/j.bjps.2023.01.034. Wrong publication type
Liu X, Zhang H, Cen S, Huang F. Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: A systematic review and meta-analysis. Int J Surg. 2018;53:72-9. Available from: https://doi.org/10.1016/j.ijsu.2018.02.064. Wrong population
Marcos MP, Campo MV, Bouza ET. Is the application of dressings on surgical wounds closed by primary intention effective at preventing infection? Gerokomos. 2015;26(2):73-5. Available from: https://doi.org/10.4321/s1134-928x2015000200008. Foreign language
Meyer J, Roos E, Abbassi Z, Toso C, Ris F, Buchs NC. The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complications after abdomino-perineal resection: a systematic review. Int J Colorectal Dis. 2021;36(1):19-26. Available from: https://doi.org/10.1007/s00384-020-03732-6. Wrong population
Mostafaei S, Norooznezhad F, Mohammadi S, Norooznezhad AH. Effectiveness of platelet-rich plasma therapy in wound healing of pilonidal sinus surgery: A comprehensive systematic review and meta-analysis. Wound Repair Regen. 2017;25(6):1002-7. Available from: https://doi.org/10.1111/wrr.12597. Wrong intervention
Mundi R, Chaudhry H, Ekhtiari S, Ajrawat P, Tushinski DM, Wood TJ, et al. Efficacy of hydrofibre dressing following total joint arthroplasty: a meta-analysis of randomised controlled trials. Hip Int. 2023;33(1):34-40. Available from: https://doi.org/10.1177/11207000211012669. Wrong outcome
Nherera LM, Saunders C, Verma S, Trueman P, Fatoye F. Single-use negative pressure wound therapy reduces costs in closed surgical incisions: UK and US economic evaluation. J Wound Care. 2021;30(Sup5):S23-S31. Available from: https://doi.org/10.12968/jowc.2021.30.Sup5.S23. Wrong publication type
Norman G, Goh EL, Dumville JC, Shi C, Liu Z, Chiverton L, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2020;6(6):CD009261. Available from: https://doi.org/10.1002/14651858.CD009261.pub6. Newer update published
Ousey KJ, Atkinson RA, Williamson JB, Lui S. Negative pressure wound therapy (NPWT) for spinal wounds: a systematic review. Spine J. 2013;13(10):1393-405. Available from: https://doi.org/10.1016/j.spinee.2013.06.040. Wrong population
Peinemann F, Labeit A. Negative pressure wound therapy: A systematic review of randomized controlled trials from 2000 to 2017. J Evid Based Med. 2019;12(2):125-32. Available from: https://doi.org/10.1111/jebm.12324. Wrong population
Peinemann F, Sauerland S. Negative-pressure wound therapy: systematic review of randomized controlled trials. Dtsch Arztebl Int. 2011;108(22):381-9. Available from: https://doi.org/10.3238/arztebl.2011.0381. Wrong population
Powell K, Pujji OJS, Jeffery S. Wound healing: what is the NICE guidance from the UK? J Wound Care. 2021;30(3):172-82. Available from: https://doi.org/10.12968/jowc.2021.30.3.172. Wrong study design
Putri IL, Adzalika LB, Pramanasari R, Wungu CDK. Negative pressure wound therapy versus conventional wound care in cancer surgical wounds: A meta-analysis of observational studies and randomised controlled trials. Int Wound J. 2022;19(6):1578-93. Available from: https://doi.org/10.1111/iwj.13756. Wrong intervention
Qian H, Lei T, Hu Y. Negative pressure wound therapy versus gauze dressings in managing open fracture wound of lower limbs: A meta-analysis of randomized controlled trials. Foot Ankle Surg. 2022;28(7):1120-8. Available from: https://doi.org/10.1016/j.fas.2022.03.012. Wrong population
Rezazadeh D, Anvari Aliabad R, Norooznezhad AH. Autologous amniotic membrane: An accelerator of wound healing for prevention of surgical site infections following Cesarean delivery. Med Hypotheses. 2020;137:109532. Available from: https://doi.org/10.1016/j.mehy.2019.109532. Wrong publication type
Rippon MG, Rogers AA, Ousey K. Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)- coated wound dressings. J Wound Care. 2021;30(4):284-96. Available from: https://doi.org/10.12968/jowc.2021.30.4.284. Wrong publication type
Robbins JM, Courtney J, Hingorani A. Systematic review of groin incision surgical site infection preventative measures in vascular surgery. J Vasc Surg. 2023;77(6):1835-50 e2. Available from: https://doi.org/10.1016/j.jvs.2023.01.209. Wrong inclusion criteria
Schlatterer DR, Hirschfeld AG, Webb LX. Negative pressure wound therapy in grade IIIB tibial fractures: fewer infections and fewer flap procedures? Clin Orthop Relat Res. 2015;473(5):1802-11. Available from: https://doi.org/10.1007/s11999-015-4140-1. Wrong population
Sharma G, Lee SW, Atanacio O, Parvizi J, Kim TK. In search of the optimal wound dressing material following total hip and knee arthroplasty: a systematic review and meta-analysis. Int Orthop. 2017;41(7):1295-305. Available from: https://doi.org/10.1007/s00264-017-3484-4. Wrong control
Singh D. The Role of Closed Incision Negative Pressure Therapy in Abdominal Wall Reconstruction: A Current Review of the Evidence. Plast Reconstr Surg. 2018;142(3 Suppl):156S-62S. Available from: https://doi.org/10.1097/PRS.0000000000004872. Wrong publication type
Slabuszewska-Jozwiak A, Szymanski JK, Jozwiak L, Sarecka-Hujar B. A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women. J. 2021;10(4):1-22. Available from: https://doi.org/10.3390/jcm10040675. Wrong intervention
Tan T, Lee H, Huang MS, Rutges J, Marion TE, Mathew J, et al. Prophylactic postoperative measures to minimize surgical site infections in spine surgery: systematic review and evidence summary. Spine J. 2020;20(3):435-47. Available from: https://doi.org/10.1016/j.spinee.2019.09.013. No synthesis of results
The Wound Healing and Management Node Group. Wet-to-dry saline moistened gauze for wound dressing. Wound Practice & Research. 2011;19(1):48-9. Wrong publication type
Totty JP, Bua N, Smith GE, Harwood AE, Carradice D, Wallace T, et al. Dialkylcarbamoyl chloride (DACC)-coated dressings in the management and prevention of wound infection: a systematic review. J Wound Care. 2017;26(3):107-14. Available from: https://doi.org/10.12968/jowc.2017.26.3.107. No synthesis of results
Walter CJ, Dumville JC, Sharp CA, Page T. Systematic review and meta-analysis of wound dressings in the prevention of surgical-site infections in surgical wounds healing by primary intention. Br J Surg. 2012;99(9):1185-94. Available from: https://doi.org/10.1002/bjs.8812. Wrong population
Wang F, Wang XY, Jiang X. Immediate air exposure vs dressings following primary closure of clean and clean-contaminated surgical wounds: a systematic review and meta-analysis of randomized controlled trials. Wounds. 2022;34(12):277-82. Available from: https://doi.org/10.25270/wnds/21151. Wrong control
Wang L, Xu X, Cao JG, Liu J. Negative pressure wound therapy in total hip and knee arthroplasty: a meta-analysis. J. 2019;8(10):791-7. Available from: https://doi.org/10.2217/cer-2019-0009. Wrong outcome
Wang QH, Zhong WF, He M. Clinical application of alginate dressing: A comparison with traditional materials. J Clin Rehab Tissue Eng Res. 2010;14(3):533-6. Available from: https://doi.org/10.3969/j.issn.1673-8225.2010.03.037. Foreign language
Wang X, Fu L, Guo S, Fang X. A meta-analysis examined the effect of topical nursing application of antimicrobial as a prophylaxis for the stoppage of surgical wound infection in colorectal surgery. Int Wound J. 2023;20(6):2010-9. Available from: https://doi.org/10.1111/iwj.14064. Wrong intervention
Wang XT, Teng YJ, Ge XJ, Ma H, Yang XL, Chen WS, et al. Effectiveness of aloe vera for acute and chronic wounds: A systematic review. Chin J Evid-Based Med. 2013;13(4):468-73. Available from: https://doi.org/10.7507/1672-2531.20130080. Unable to order and read in full text
Wang YJ, Yao XF, Lin YS, Wang JY, Chang CC. Oncologic feasibility for negative pressure wound therapy application in surgical wounds: A meta-analysis. Int Wound J. 2022;19(3):573-82. Available from: https://doi.org/10.1111/iwj.13654. Wrong population
Webster J, Liu Z, Norman G, Dumville JC, Chiverton L, Scuffham P, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2019;3(3):CD009261. Available from: https://doi.org/10.1002/14651858.CD009261.pub4. Newer update published
Webster J, Scuffham P, Sherriff KL, Stankiewicz M, Chaboyer WP. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database Syst Rev. 2012(4):CD009261. Available from: https://doi.org/10.1002/14651858.CD009261.pub2. Newer update published
Webster J, Scuffham P, Stankiewicz M, Chaboyer WP. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database Syst Rev. 2014(10):CD009261. Available from: https://doi.org/10.1002/14651858.CD009261.pub3. Newer update published
Xiaohui HU, Yingxuan GU, Huang L, Shuting LU, Chen L, Yingtao LAI. Effect of hydrophilic fiber silver dressing on improving wound recovery after total hip or knee replacement: a Meta-analysis. Chinese Nursing Research. 2021;35(5). Available from: https://doi.org/10.12102/j.issn.1009-6493.2021.05.007. Foreign language
Yilmaz AC, Aygin D. Honey Dressing in Wound Treatment: A Systematic Review. Complement Ther Med. 2020;51:102388. Available from: https://doi.org/10.1016/j.ctim.2020.102388. Wrong population
Yilmaz E, Blecher R, Moisi M, Ankush C, O'Lynnger TM, Abdul-Jabbar A, et al. Is There an Optimal Wound Closure Technique for Major Posterior Spine Surgery? A Systematic Review. Global Spine J. 2018;8(5):535-44. Available from: https://doi.org/10.1177/2192568218774323. Wrong publication type
Yuan Y, Li J, Wang K, Zheng G, Chai S. The effect of different wound dressing materials used in postoperative treatment of wounds after total hip arthroplasty and total knee arthroplasty: A meta-analysis. Int Wound J. 2022;19(8):2107-14. Available from: https://doi.org/10.1111/iwj.13816. Wrong population
Zhao AH, Kwok CHR, Jansen SJ. How to Prevent Surgical Site Infection in Vascular Surgery: A Review of the Evidence. Ann Vasc Surg. 2022;78:336-61. Available from: https://doi.org/10.1016/j.avsg.2021.06.045. Wrong publication type
Zwanenburg PR, Tol BT, de Vries FEE, Boermeester MA. Incisional Negative Pressure Wound Therapy for Surgical Site Infection Prophylaxis in the Post-Antibiotic Era. Surg Infect (Larchmt). 2018;19(8):821-30. Available from: https://doi.org/10.1089/sur.2018.212. Wrong publication type

Bilaga 4 Risk för bias hos relevanta systematiska översikter

*ROB = Risk of Bias. The risk of bias of included systematic reviews is appraised using an assessment tool based on AMSTAR revised by SBU. The assessment tool is comprised of six steps based on the items in AMSTAR. Systematic reviews that did not meet the requirements in steps one to three were not assessed further. A systematic review is of moderate risk of bias if it fulfills all the requirements up to step four. For low risk of bias, steps five and six must also be fulfilled
Publication RoB* Comment
Ailaney N, Johns WL, Golladay GJ, Strong B, Kalore NV. Closed Incision Negative Pressure Wound Therapy for Elective Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty. 2021;36(7):2402-11. Available from: https://doi.org/10.1016/j.arth.2020.11.039. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification No/insufficient risk of bias assessment of included primary studies
Almansa-Saura S, Lopez-Lopez V, Eshmuminov D, Schneider M, Castellanos-Escrig G, Rodriguez-Valiente M, et al. Prophylactic Use of Negative Pressure Therapy in General Abdominal Surgery: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt). 2021;22(8):854-63. Available from: https://doi.org/10.1089/sur.2020.407. High No/insufficient risk of bias assessment of included primary studies
Angarita AM, Jayakumaran J, Di Mascio D, Berghella V. Prophylactic negative pressure wound therapy on wound complications after cesarean delivery in women with obesity: a meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM. 2022;4(3):100617. Available from: https://doi.org/10.1016/j.ajogmf.2022.100617. High No/insufficient risk of bias assessment of included primary studies
Antoniou GA, Onwuka CC, Antoniou SA, Russell D. Meta-analysis and trial sequential analysis of prophylactic negative pressure therapy for groin wounds in vascular surgery. J Vasc Surg. 2019;70(5):1700-10 e6. Available from: https://doi.org/10.1016/j.jvs.2019.01.083. High Methodological inconsistencies
Berner-Hansen V, Oma E, Willaume M, Jensen KK. Prophylactic negative pressure wound therapy after open ventral hernia repair: a systematic review and meta-analysis. Hernia. 2021;25(6):1481-90. Available from: https://doi.org/10.1007/s10029-021-02485-7. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Biancari F, Santoro G, Provenzano F, Savarese L, Iorio F, Giordano S, et al. Negative-Pressure Wound Therapy for Prevention of Sternal Wound Infection after Adult Cardiac Surgery: Systematic Review and Meta-Analysis. J. 2022;11(15):22. Available from: https://doi.org/10.3390/jcm11154268. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No/insufficient risk of bias assessment of included primary studies
Boland PA, Kelly ME, Donlon NE, Bolger JC, Mehigan BJ, McCormick PH, et al. Prophylactic negative pressure wound therapy for closed laparotomy wounds: a systematic review and meta-analysis of randomised controlled trials. Ir J Med Sci. 2021;190(1):261-7. Available from: https://doi.org/10.1007/s11845-020-02283-7. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Boll G, Callas P, Bertges DJ. Meta-analysis of prophylactic closed-incision negative pressure wound therapy for vascular surgery groin wounds. J Vasc Surg. 2022;75(6):2086-93 e9. Available from: https://doi.org/10.1016/j.jvs.2021.12.070. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Cagney D, Simmons L, O'Leary DP, Corrigan M, Kelly L, O'Sullivan MJ, et al. The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis. World J Surg. 2020;44(5):1526-37. Available from: https://doi.org/10.1007/s00268-019-05335-x. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No/insufficient risk of bias assessment of included primary studies
Chen KK, Elbuluk AM, Vigdorchik JM, Long WJ, Schwarzkopf R. The effect of wound dressings on infection following total joint arthroplasty. Arthroplast Today. 2018;4(1):125-9. Available from: https://doi.org/10.1016/j.artd.2017.03.002. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Chen Z, Bains SS, Sax OC, Sodhi N, Mont MA. Dressing Management during Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Knee Surg. 2022;35(14):1524-32. Available from: https://doi.org/10.1055/s-0042-1758674. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Chen Z, Sun J, Yao Z, Song C, Liu W. Can prophylactic negative pressure wound therapy improve clinical outcomes in spinal fusion surgery? A meta-analysis. Eur Spine J. 2022;31(6):1546-52. Available from: https://doi.org/10.1007/s00586-022-07178-y. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No/insufficient risk of bias assessment of included primary studies
Cooper HJ, Silverman RP, Collinsworth A, Bongards C, Griffin L. Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies. Arthroplast Today. 2023;21:101120. Available from: https://doi.org/10.1016/j.artd.2023.101120. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No/insufficient risk of bias assessment of included primary studies
Cooper HJ, Singh DP, Gabriel A, Mantyh C, Silverman R, Griffin L. Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2023;11(3):e4722. Available from: https://doi.org/10.1097/GOX.0000000000004722. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No/insufficient risk of bias assessment of included primary studies
Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, et al. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev. 2016;12(12):CD003091. Available from: https://doi.org/10.1002/14651858.CD003091.pub4. Low  
De Vries FEE, Wallert ED, Solomkin JS, Allegranzi B, Egger M, Dellinger EP, et al. A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery. Medicine (Baltimore). 2016;95(36):e4673. Available from: https://doi.org/10.1097/MD.0000000000004673. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No/insufficient risk of bias assessment of included primary studies
Dias TA, Fernandes DR, Dos Santos BN, Dos Reis PED, Margatho AS, Silveira R. Dressing to prevent surgical site infection in adult patients with cancer: a systematic review with meta-analysis. Support Care Cancer. 2022;31(1):11. Available from: https://doi.org/10.1007/s00520-022-07467-8. High No documentation of literature search strategy – risk of biased study identification
Dongmei G. The Safety of Negative-Pressure Wound Therapy on Surgical Wounds: An Updated Meta-analysis of 17 Randomized Controlled Trials. Adv Skin Wound Care. 2018;31(9):421-8. Available from: https://doi.org/10.1097/01.ASW.0000542530.71686.5c. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Methodological inconsistencies
Elhage KG, Awad ME, Irfan FB, Lumbley J, Mostafa G, Saleh KJ. Closed-incision negative pressure therapy at -125 mmHg significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta-analysis of randomized controlled trials. Health Sci Rep. 2022;5(1):e425. Available from: https://doi.org/10.1002/hsr2.425. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Gillespie BM, Thalib L, Ellwood D, Kang E, Mahomed K, Kumar S, et al. Effect of negative-pressure wound therapy on wound complications in obese women after caesarean birth: a systematic review and meta-analysis. BJOG. 2022;129(2):196-207. Available from: https://doi.org/10.1111/1471-0528.16963. Moderate  
Gombert A, Dillavou E, D'Agostino R, Jr., Griffin L, Robertson JM, Eells M. A systematic review and meta-analysis of randomized controlled trials for the reduction of surgical site infection in closed incision management versus standard of care dressings over closed vascular groin incisions. Vascular. 2020;28(3):274-84. Available from: https://doi.org/10.1177/1708538119890960. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Gong S, Yang J, Lu T, Tian H, Huang Y, Song S, et al. Incisional negative pressure wound therapy for clean-contaminated wounds in abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. Expert Rev Gastroenterol Hepatol. 2021;15(11):1309-18. Available from: https://doi.org/10.1080/17474124.2021.1967143. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Guo C, Cheng T, Li J. Prophylactic negative pressure wound therapy for closed laparotomy incisions after ventral hernia repair: A systematic review and meta-analysis. Int J Surg. 2022;97:106216. Available from: https://doi.org/10.1016/j.ijsu.2021.106216. High Methodological inconsistencies
Guo C, Cheng T, Li J. Prophylactic negative pressure wound therapy on surgical site infection in obese women after cesarean section: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2022;158(3):502-11. Available from: https://doi.org/10.1002/ijgo.14058. High Insufficient/inadequate synthesis of results
Hays TR, Singh G, Saragossi J, Park J, Shekar S, Marquez JE, et al. Negative-Pressure Wound Therapy versus Standard Surgical Dressings after Malignant Tumor Resection: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2022;150(3):655e-70e. Available from: https://doi.org/10.1097/PRS.0000000000009448. High No/insufficient risk of bias assessment of included primary studies
Hong J, Xie L, Fan L, Huang H. The wound adjuncts effect of closed incision negative pressure wound therapy on stopping groin surgical site wound infection in arterial surgery: A meta-analysis. Int Wound J. 2023;20(7):2726-34. Available from: https://doi.org/10.1111/iwj.14146. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No/insufficient risk of bias assessment of included primary studies
Huang HP, Zhao WJ, Pu J, He F. Prophylactic negative pressure wound therapy for surgical site infection in obese women undergoing cesarean section: an evidence synthesis with trial sequential analysis. J Matern Fetal Neonatal Med. 2021;34(15):2498-505. Available from: https://doi.org/10.1080/14767058.2019.1668924. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Hyldig N, Birke-Sorensen H, Kruse M, Vinter C, Joergensen JS, Sorensen JA, et al. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg. 2016;103(5):477-86. Available from: https://doi.org/10.1002/bjs.10084. High Methodological inconsistencies
Ingargiola MJ, Daniali LN, Lee ES. Does the application of incisional negative pressure therapy to high-risk wounds prevent surgical site complications? A systematic review. Eplasty. 2013;13:e49. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Jiang N, Rao F, Xiao J, Yang J, Wang W, Li Z, et al. Evaluation of different surgical dressings in reducing postoperative surgical site infection of a closed wound: A network meta-analysis. Int J Surg. 2020;82:24-9. Available from: https://doi.org/10.1016/j.ijsu.2020.07.066. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Kim JH, Kim HJ, Lee DH. Comparison of the Efficacy Between Closed Incisional Negative-Pressure Wound Therapy and Conventional Wound Management After Total Hip and Knee Arthroplasties: A Systematic Review and Meta-Analysis. J Arthroplasty. 2019;34(11):2804-14. Available from: https://doi.org/10.1016/j.arth.2019.06.020. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Inadequate synthesis of results
Kim JH, Lee DH. Are high-risk patient and revision arthroplasty effective indications for closed-incisional negative-pressure wound therapy after total hip or knee arthroplasty? A systematic review and meta-analysis. Int Wound J. 2020;17(5):1310-22. Available from: https://doi.org/10.1111/iwj.13393. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No/insufficient risk of bias assessment of included primary studies
Inadequate synthesis of results
Kirkham AM, Candeliere J, McIsaac DI, Stelfox HT, Dubois L, Gill HL, et al. Efficacy of Strategies Intended to Prevent Surgical Site Infection After Lower Limb Revascularization Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Surg. 2023;278(3):e447-e56. Available from: https://doi.org/10.1097/SLA.0000000000005867. Moderate  
Kuo FC, Hsu CW, Tan TL, Lin PY, Tu YK, Chen PC. Effectiveness of Different Wound Dressings in the Reduction of Blisters and Periprosthetic Joint Infection After Total Joint Arthroplasty: A Systematic Review and Network Meta-Analysis. J Arthroplasty. 2021;36(7):2612-29. Available from: https://doi.org/10.1016/j.arth.2021.02.047. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
K Kuper TM, Murphy PB, Kaur B, Ott MC. Prophylactic Negative Pressure Wound Therapy for Closed Laparotomy Incisions: A Meta-analysis of Randomized Controlled Trials. Ann Surg. 2020;271(1):67-74. Available from: https://doi.org/10.1097/SLA.0000000000003435. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Lambrechts MJ, D'Antonio ND, Issa TZ, Levy HA, Yalla GR, Berthiaume E, et al. The Usefulness of Closed Incision Negative Pressure Wound Therapy After Spinal Fusion: A Systematic Review and Meta-Analysis. World Neurosurg. 2022;168:258-67 e1. Available from: https://doi.org/10.1016/j.wneu.2022.09.048. High Methodological inconsistencies
Leach H. The efficacy of closed incision negative pressure wound therapy to reduce surgical site infections: a systematic review. Wounds International. 2021;12(2):34-40. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Lenet T, Gilbert RWD, Abou-Khalil J, Balaa FK, Martel G, Brind'Amour A, et al. The impact of prophylactic negative pressure wound therapy on surgical site infections in pancreatic resection: A systematic review and meta-analysis. HPB (Oxford). 2022;24(12):2035-44. Available from: https://doi.org/10.1016/j.hpb.2022.08.010. High No/insufficient risk of bias assessment of included primary studies
Li HZ, Zhang L, Chen JX, Zheng Y, Zhu XN. Silver-containing dressing for surgical site infection in clean and clean-contaminated operations: a systematic review and meta-analysis of randomized controlled trials. J Surg Res. 2017;215:98-107. Available from: https://doi.org/10.1016/j.jss.2017.03.040. High Incomplete/inadequate synthesis of results
Li Y, Wu B, Liu Y. The Effect of Negative Pressure Therapy on Closed Wound After the Orthopedic Surgery of Lower Limb: A Meta-Analysis. Surg Innov. 2020;27(2):165-72. Available from: https://doi.org/10.1177/1553350619893222. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Liew AN, Lim KY, Khoo JF. Closed Incision Negative Pressure Therapy vs Standard of Care Dressing in Breast Surgery: A Systematic Review. Cureus. 2022;14(4):e24499. Available from: https://doi.org/10.7759/cureus.24499. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Matar HE, Emms N, Raut V. Effectiveness of Negative-Pressure Wound Therapy following Total Hip and Knee Replacements. J Long Term Eff Med Implants. 2019;29(1):51-7. Available from: https://doi.org/10.1615/JLongTermEffMedImplants.2019030593. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identificationIncomplete/inadequate synthesis of results
Meyer J, Roos E, Abbassi Z, Buchs NC, Ris F, Toso C. Prophylactic Negative-pressure Wound Therapy Prevents Surgical Site Infection in Abdominal Surgery: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies. Clin Infect Dis. 2021;73(11):e3804-e13. Available from: https://doi.org/10.1093/cid/ciaa1203. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Meyer J, Roos E, Davies RJ, Buchs NC, Ris F, Toso C. Does Prophylactic Negative-Pressure Wound Therapy Prevent Surgical Site Infection After Laparotomy? A Systematic Review and Meta-analysis of Randomized Controlled trials. World J Surg. 2023;47(6):1464-74. Available from: https://doi.org/10.1007/s00268-023-06908-7. Moderate  
Nelson RL, Iqbal NM, Kravets A, Khateeb R, Raza M, Siddiqui M, et al. Topical antimicrobial prophylaxis in colorectal surgery for the prevention of surgical wound infection: a systematic review and meta-analysis. Tech Coloproctol. 2018;22(8):573-87. Available from: https://doi.org/10.1007/s10151-018-1814-1. High Insufficient reporting of characteristics of included primary studies
Norman G, Shi C, Goh EL, Murphy EM, Reid A, Chiverton L, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2022;4(4):CD009261. Available from: https://doi.org/10.1002/14651858.CD009261.pub7. Low  
Ren B, Jiang X, Chen J, Mo J. The efficacy of negative pressure wound therapy after hepatopancreatobiliary surgery: A systematic review and meta-analysis. Pak J Med Sci. 2022;38(8):2356-64. Available from: https://doi.org/10.12669/pjms.38.8.6601. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Sahebally SM, McKevitt K, Stephens I, Fitzpatrick F, Deasy J, Burke JP, et al. Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery: A Systematic Review and Meta-analysis. JAMA Surg. 2018;153(11):e183467. Available from: https://doi.org/10.1001/jamasurg.2018.3467. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No/insufficient risk of bias assessment of included primary studies
Sandy-Hodgetts K, Watts R. Effectiveness of negative pressure wound therapy/closed incision management in the prevention of post-surgical wound complications: a systematic review and meta-analysis. JBI Database System Rev Implement Rep. 2015;13(1):253-303. Available from: https://doi.org/10.11124/jbisrir-2015-1687. Moderate  
Saunders C, Nherera LM, Horner A, Trueman P. Single-use negative-pressure wound therapy versus conventional dressings for closed surgical incisions: systematic literature review and meta-analysis. BJS open. 2021;5(1). Available from: https://doi.org/https://dx.doi.org/10.1093/bjsopen/zraa003. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Semsarzadeh NN, Tadisina KK, Maddox J, Chopra K, Singh DP. Closed Incision Negative-Pressure Therapy Is Associated with Decreased Surgical-Site Infections: A Meta-Analysis. Plast Reconstr Surg. 2015;136(3):592-602. Available from: https://doi.org/10.1097/PRS.0000000000001519. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No risk of bias assessment of included primary studies
Sexton F, Healy D, Keelan S, Alazzawi M, Naughton P. A systematic review and meta-analysis comparing the effectiveness of negative-pressure wound therapy to standard therapy in the prevention of complications after vascular surgery. Int J Surg. 2020;76:94-100. Available from: https://doi.org/10.1016/j.ijsu.2020.02.037. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Methodological inconsistencies
Shiroky J, Lillie E, Muaddi H, Sevigny M, Choi WJ, Karanicolas PJ. The impact of negative pressure wound therapy for closed surgical incisions on surgical site infection: A systematic review and meta-analysis. Surgery. 2020;167(6):1001-9. Available from: https://doi.org/10.1016/j.surg.2020.01.018. High Incomplete/inadequate synthesis of results
Singh DP, Gabriel A, Parvizi J, Gardner MJ, D'Agostino R, Jr. Meta-Analysis of Comparative Trials Evaluating a Single-Use Closed-Incision Negative-Pressure Therapy System. Plast Reconstr Surg. 2019;143(1S Management of Surgical Incisions Utilizing Closed-Incision Negative-Pressure Therapy):41S-6S. Available from: https://doi.org/10.1097/PRS.0000000000005312. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No risk of bias assessment of included primary studies
Singh DP, Gabriel A, Silverman RP, Griffin LP, McGowan LD, D'Agostino RB, Jr. Meta-analysis Comparing Outcomes of Two Different Negative Pressure Therapy Systems in Closed Incision Management. Plast Reconstr Surg Glob Open. 2019;7(6):e2259. Available from: https://doi.org/10.1097/GOX.0000000000002259. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No risk of bias assessment of included primary studies
Smid MC, Dotters-Katz SK, Grace M, Wright ST, Villers MS, Hardy-Fairbanks A, et al. Prophylactic Negative Pressure Wound Therapy for Obese Women After Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol. 2017;130(5):969-78. Available from: https://doi.org/10.1097/AOG.0000000000002259. High Methodological inconsistencies
Smolle MA, Nischwitz SP, Hutan M, Trunk P, Lumenta D, Bernhardt GA. Closed-incision negative-pressure wound management in surgery—literature review and recommendations. Eur Surg Acta Chir Austriaca. 2020;52(6):249-67. Available from: https://doi.org/10.1007/s10353-020-00657-w. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Song J, Liu X, Wu T. Effectiveness of prophylactic application of negative pressure wound therapy in stopping surgical site wound problems for closed incisions in breast cancer surgery: A meta-analysis. Int Wound J. 2023;20(2):241-50. Available from: https://doi.org/10.1111/iwj.13866. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Strugala V, Martin R. Meta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications. Surg Infect (Larchmt). 2017;18(7):810-9. Available from: https://doi.org/10.1089/sur.2017.156. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
No risk of bias assessment of included primary studies
Sun W, Chen M, Duan D, Liu W, Cui W, Li L. Effectiveness of moist dressings in wound healing after surgical suturing: A Bayesian network meta-analysis of randomised controlled trials. Int Wound J. 2023;20(1):69-78. Available from: https://doi.org/10.1111/iwj.13839. High Methodological inconsistencies
Svensson-Bjork R, Zarrouk M, Asciutto G, Hasselmann J, Acosta S. Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery. Br J Surg. 2019;106(4):310-8. Available from: https://doi.org/10.1002/bjs.11100. Moderate  
Swanson EW, Cheng H-T, Susarla SM, Lough DM, Kumar AR. Does negative pressure wound therapy applied to closed incisions following ventral hernia repair prevent wound complications and hernia recurrence? A systematic review and meta-analysis. Plast Surg (Oakv). 2016;24(2):113-8. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Tian Y, Li K, Zeng L. A systematic review with meta-analysis on prophylactic negative pressure wound therapy versus standard dressing for obese women after caesarean section. Nurs Open. 2023;10(9):5999-6013. Available from: https://doi.org/10.1002/nop2.1912. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Methodological inconsistencies
Tran BNN, Johnson AR, Shen C, Lee BT, Lee ES. Closed-Incision Negative-Pressure Therapy Efficacy in Abdominal Wall Reconstruction in High-Risk Patients: A Meta-analysis. J Surg Res. 2019;241:63-71. Available from: https://doi.org/10.1016/j.jss.2019.03.033. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Wang C, Zhang Y, Qu H. Negative pressure wound therapy for closed incisions in orthopedic trauma surgery: a meta-analysis. J Orthop Surg Res. 2019;14(1):427. Available from: https://doi.org/10.1186/s13018-019-1488-z. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Wee IJY, Syn N, Choong A. Closed Incision Negative Pressure Wound Therapy in Vascular Surgery: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2019;58(3):446-54. Available from: https://doi.org/10.1016/j.ejvs.2018.12.021. Moderate  
Wells CI, Ratnayake CBB, Perrin J, Pandanaboyana S. Prophylactic Negative Pressure Wound Therapy in Closed Abdominal Incisions: A Meta-analysis of Randomised Controlled Trials. World J Surg. 2019;43(11):2779-88. Available from: https://doi.org/10.1007/s00268-019-05116-6. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Wijetunge S, Hill R, Katie Morris R, Hodgetts Morton V. Advanced dressings for the prevention of surgical site infection in women post-caesarean section: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;267:226-33. Available from: https://doi.org/10.1016/j.ejogrb.2021.11.014. High Methodological inconsistencies
Xie R, Li B, Wen F. Effect of prophylactic negative pressure treatment for post-surgery groin wounds management in vascular surgery: A meta-analysis. Int Wound J. 2023;20(2):269-77. Available from: https://doi.org/10.1111/iwj.13870. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Xie W, Dai L, Qi Y, Jiang X. Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta-analysis. Int Wound J. 2022;19(6):1319-28. Available from: https://doi.org/10.1111/iwj.13726. High Methodological inconsistencies
Yaghmour KM, Hossain FS, Konan S. Clinical and Health-Care Cost Analysis of Negative Pressure Dressing in Primary and RevisionTotal Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am. 2020;Publish Ahead of Print:541-8. Available from: https://doi.org/10.2106/JBJS.20.01254. High Insufficient reporting of characteristics of included primary studiesPoorly executed synthesis of results
Yu L, Kronen RJ, Simon LE, Stoll CRT, Colditz GA, Tuuli MG. Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis. Am J Obstet Gynecol. 2018;218(2):200-10 e1. Available from: https://doi.org/10.1016/j.ajog.2017.09.017. High No/insufficient risk of bias assessment of included primary studies
Yuan S, Zhang T, Zhang D, He Q, Du M, Zeng F. Impact of negative pressure wound treatment on incidence of surgical site infection in varied orthopedic surgeries: A systematic review and meta-analysis. Int Wound J. 2023;20(6):2334-45. Available from: https://doi.org/10.1111/iwj.14043. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Zhang D, He L. A systemic review and a meta-analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings. Int Wound J. 2023;20(1):46-54. Available from: https://doi.org/10.1111/iwj.13835. High Methodological inconsistencies
Zhu J, Sun Q, Xu W, Geng J, Feng Q, Zhao Z, et al. Effect of Negative Pressure Wound Therapy on Surgical Site Infections following Stoma Reversal in Colorectal Surgery: A Meta-Analysis. J Invest Surg. 2023:2175079. Available from: https://doi.org/10.1080/08941939.2023.2175079. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Zhu Y, Dai L, Luo B, Zhang L. Meta-analysis of prophylactic negative pressure wound therapy for surgical site infections (SSI) in caesarean section surgery. Wideochir Inne Tech Maloinwazyjne. 2023;18(2):224-34. Available from: https://doi.org/10.5114/wiitm.2023.125913. High Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Zwanenburg PR, Tol BT, Obdeijn MC, Lapid O, Gans SL, Boermeester MA. Meta-analysis, Meta-regression, and GRADE Assessment of Randomized and Nonrandomized Studies of Incisional Negative Pressure Wound Therapy Versus Control Dressings for the Prevention of Postoperative Wound Complications. Ann Surg. 2020;272(1):81-91. Available from: https://doi.org/10.1097/SLA.0000000000003644. Moderate  

Bilaga 5 Granskningsmall för att översiktligt bedöma risken för snedvridning/ systematiska fel hos systematiska översikter

Bilaga 5 Granskningsmall för att översiktligt bedöma risken för snedvridning/ systematiska fel hos systematiska översikter (PDF)