Closed incision NPWT: 1017 women | Standard dressing: 1018 women
There was no significant difference in the incidence of SSI between the intervention groups
Closed incision NPWT: 7.4%
Standard dressing: 9.7%
Risk ratio 0.76 (95% CI, 0.57 to 1.01); P = 0.06
Post hoc analyses to explore the effect of missing data found the same direction of effect (closed incision NPWT reducing SSI), as well as statistical significance
Blistering occurred in more women who received closed incision NPWT
Closed incision NPWT: 4.0%
Standard dressing: 2.3%
Risk ratio 1.72 (95% CI, 1.04 to 2.85); P = 0.03
While there was a 3% absolute risk reduction for SSI using closed incision NPWT, the result was not statistically significant
Women who received closed incision NPWT were more likely to experience skin blistering
Exclusion of emergent cesareans which would include women at high risk for SSI
Lower than expected cumulative SSI incidence, which could lead to a false negative result (type II error)
The authors conclude
This difference, although close to statistical significance, possibly underestimates the effectiveness of closed incision NPWT in this population
On balance, the results of the conservative primary, multivariable adjusted model, and post hoc sensitivity analyses should be considered alongside the growing body of evidence of the benefits of closed incision NPWT and given the number of obese women undergoing caesarean section globally
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