OBJECTIVE:The aim of this study was to evaluate the efficacy of iNPWT for the prevention of postoperative wound complications such as SSI. SUMMARY OF BACKGROUND DATA:The 2016 WHO recommendation on the use of iNPWT for the prevention of SSI is based on low-level evidence, and many trials have been published since. Preclinical evidence suggests that iNPWT may also prevent wound dehiscence, skin necrosis, seroma, and hematoma. METHODS:PubMed, EMBASE, CINAHL, and CENTRAL were searched for randomized and nonrandomized studies that compared iNPWT with control dressings. The evidence was assessed using the Cochrane Risk of Bias Tool, the Newcastle-Ottawa scale, and GRADE. Meta-analyses were performed using random-effects models. RESULTS:High level evidence indicated that iNPWT reduced SSI 28 RCTs, n = 4398, relative risk (RR) 0.61, 95% confidence interval CI0.49–0.76, P < 0.0001, I = 27% with a number needed to treat of 19. Low level evidence indicated that iNPWT reduced wound dehiscence (16 RCTs, n = 3058, RR 0.78, 95% CI0.64–0.94). Very low-level evidence indicated that iNPWT also reduced skin necrosis (RR 0.49, 95% CI0.33–0.74), seroma (RR 0.43, 95% CI0.32–0.59), and length of stay (pooled mean difference −2.01, 95% CI−2.99 to 1.14). CONCLUSIONS:High-level evidence indicates that incisional iNPWT reduces the risk of SSI with limited heterogeneity. Low to very low-level evidence indicates that iNPWT also reduces the risk of wound dehiscence, skin necrosis, and seroma.