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Study flow diagram
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Figure 1

Study flow diagram

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 1 Superficial surgical site infection.
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Analysis 1.1

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 1 Superficial surgical site infection.

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 2 Superficial wound dehiscence.
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Analysis 1.2

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 2 Superficial wound dehiscence.

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 3 Deep wound dehiscence.
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Analysis 1.3

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 3 Deep wound dehiscence.

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 4 Hospital stay.
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Analysis 1.4

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 4 Hospital stay.

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 5 Superficial surgical site infection (sensitivity analysis ‐ missing data imputation).
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Analysis 1.5

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 5 Superficial surgical site infection (sensitivity analysis ‐ missing data imputation).

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 6 Hospital stay (sensitivity analysis).
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Analysis 1.6

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 6 Hospital stay (sensitivity analysis).

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 7 Superficial surgical site infection (sensitivity analysis ‐ > 30 days).
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Analysis 1.7

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 7 Superficial surgical site infection (sensitivity analysis ‐ > 30 days).

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 8 Superficial wound dehiscence (sensitivity analysis ‐ > 30 days).
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Analysis 1.8

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 8 Superficial wound dehiscence (sensitivity analysis ‐ > 30 days).

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Summary of findings for the main comparison. Subcutaneous closure compared to no subcutaneous closure for non‐caesarean surgery

Subcutaneous closure compared to no subcutaneous closure for non‐caesarean surgery

Patient or population: participants having non‐caesarean surgery
Settings: secondary
Intervention: subcutaneous closure of incision
Comparison: no subcutaneous closure of incision

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

No subcutaneous closure

Subcutaneous closure

Superficial surgical site infection

83 per 1000

70 per 1000
(44 to 110)

RR 0.84
(0.53 to 1.33)

815
(6 studies)

⊕⊝⊝⊝
very low1,2

Superficial wound dehiscence

103 per 1000

58 per 1000
(23 to 145)

RR 0.56
(0.22 to 1.41)

215
(2 studies)

⊕⊝⊝⊝
very low1,2

Deep wound dehiscence

133 per 1000

33 per 1000
(4 to 281)

RR 0.25
(0.03 to 2.11)

60
(1 study)

⊕⊝⊝⊝
very low1,2

Hospital stay

The mean hospital stay in the control groups was
6 days

The mean hospital stay in the intervention groups was
0.1 higher
(0.45 lower to 0.64 higher)

434
(3 studies)

⊕⊝⊝⊝
very low1,3

*The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: we are very uncertain about the estimate

1 The trial(s) was (were) of high risk of bias
2 The confidence intervals overlapped 1 and either 0.75 or 1.25 or both. The number of events in the intervention and control group was fewer than 300
3 There was severe heterogeneity as noted by the I2 statistic and the lack of overlap of confidence intervals

Figuras y tablas -
Summary of findings for the main comparison. Subcutaneous closure compared to no subcutaneous closure for non‐caesarean surgery
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Comparison 1. Subcutaneous closure versus no subcutaneous closure

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Superficial surgical site infection Show forest plot

6

815

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.53, 1.33]

2 Superficial wound dehiscence Show forest plot

2

215

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.22, 1.41]

3 Deep wound dehiscence Show forest plot

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.11]

4 Hospital stay Show forest plot

3

434

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.45, 0.64]

5 Superficial surgical site infection (sensitivity analysis ‐ missing data imputation) Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Best‐best analysis

6

824

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.52, 1.32]

5.2 Best‐worst analysis

6

824

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.47, 1.16]

5.3 Worst‐best analysis

6

824

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.63, 1.52]

5.4 Worst‐worst analysis

6

824

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.57, 1.33]

6 Hospital stay (sensitivity analysis) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7 Superficial surgical site infection (sensitivity analysis ‐ > 30 days) Show forest plot

3

434

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.25, 1.19]

8 Superficial wound dehiscence (sensitivity analysis ‐ > 30 days) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Subcutaneous closure versus no subcutaneous closure
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