Abstract: Four trials were identified for inclusion in this review. All the trials were at high risk of bias. Three trials provided information for this review. Overall, this review included 280 people undergoing planned surgery. Participants were randomised to early dressing removal (removal of the wound dressing within the 48 hours following surgery) (n = 140) or delayed dressing removal (continued dressing of the wound beyond 48 hours) (n = 140) in the three trials. There were no statistically significant differences between the early dressing removal group and delayed dressing removal group in the proportion of people who developed superficial surgical site infection within 30 days (RR 0.64; 95% CI 0.32 to 1.28), superficial wound dehiscence within 30 days (RR 2.00; 95% CI 0.19 to 21.16) or serious adverse events within 30 days (RR 0.83; 95% CI 0.28 to 2.51). No deep wound infection or deep wound dehiscence occurred in any of the participants in the trials that reported this outcome. None of the trials reported quality of life. The hospital stay was significantly shorter (MD -2.00 days; 95% CI -2.82 to -1.18) and the total cost of treatment significantly less (MD EUR -36.00; 95% CI -59.81 to -12.19) in the early dressing removal group than in the delayed dressing removal group in the only trial that reported these outcomes. The early removal of dressings from clean or clean contaminated surgical wounds appears to have no detrimental effect on outcomes. However, it should be noted that the point estimate supporting this statement is based on very low quality evidence from three small randomised controlled trials, and the confidence intervals around this estimate were wide. Early dressing removal may result in a significantly shorter hospital stay, and significantly reduced costs, than covering the surgical wound with wound dressings beyond the first 48 hours after surgery, according to very low quality evidence from one small randomised controlled trial. Further randomised controlled trials of low risk of bias are necessary to investigate whether dressings are necessary after 48 hours in different types of surgery and levels of contamination and investigate whether antibiotic therapy influences the outcome

Plain-language summary: We reviewed the medical literature up to July 2013 and identified four randomised controlled trials that investigated early (permanent removal of dressings within 48 hours of surgery) versus delayed removal of dressings (permanent removal of dressings after 48 hours of surgery with interim changes of dressing allowed) in people with surgical wounds. The levels of bias across the studies were mostly high or unclear, i.e. flaws in the conduct of these trials could have resulted in the production of incorrect results. A total of 280 people undergoing planned surgery were included in this review. One-hundred and forty people had their dressings removed within 48 hours following surgery and 140 people had their wounds dressed beyond 48 hours. The choice of whether the dressing was removed early (within 48 hours) or retained for more 48 hours was made randomly by a method similar to the toss of a coin. No significant differences were reported between the two groups in terms of superficial surgical site infection (infection of the wound), superficial wound dehiscence (partial disruption of the wound that results in it reopening at the skin surface) or the number of people experiencing serious adverse events. There were no deep wound infections or complete wound dehiscence (complete disruption of wound healing, when the wound reopens completely) in the studies that reported these complications. However, the studies were not large enough to identify small differences in complication rates. None of the studies reported quality of life. Participants in the group that had early removal of dressings had significantly shorter hospital stays and incurred significantly lower treatment costs than those in the delayed removal of dressings group, but these results were based on very low quality evidence from one small randomised controlled trial. We recommend further randomised controlled trials are performed to investigate whether dressing of wounds beyond 48 hours after surgery is necessary, since the current evidence is based on very low quality evidence from three small randomised controlled trials.