Negative Pressure Wound Therapy Versus Standard Dressings for Preventing Surgical Site Infections Following Abdominal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND

Surgical site infections (SSIs) are among the most frequent postoperative complications, contributing significantly to patient morbidity, prolonged hospital stays, and increased healthcare costs. Prophylactic negative pressure wound therapy (ciNPWT) has emerged as a potential strategy to reduce SSIs, particularly in abdominal surgery, but its effectiveness remains debated.

OBJECTIVE

To evaluate the effectiveness of ciNPWT in reducing SSI rates and other surgical outcomes following abdominal surgery by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

We performed a comprehensive meta-analysis of RCTs assessing the use of ciNPWT versus standard wound care in abdominal surgeries including mixed wound contamination classes (e.g., clean-contaminated to contaminated/dirty procedures). The protocol was registered with PROSPERO (https://www.crd.york.ac.uk/prospero/Registration ID: CRD420251005562). Primary outcomes included SSI incidence, while secondary outcomes comprised mortality, hematoma, hospital readmission, reoperation, length of stay, and other incisional complications. Sensitivity analyses and trial sequential analyses were conducted to assess the robustness of findings.

RESULTS

A total of 11 studies involving 2519 patients were included. NPWT significantly reduced the risk of surgical site infection compared to standard dressings (RR = 0.61 (95% CI: 0.44-0.86); p = 0.004). Substantial heterogeneity was present (I2 = 66%; p for heterogeneity = 0.001), which was not resolved by sensitivity analyses. No significant differences were observed in mortality (RR = 0.90 (95% CI: 0.48-1.69); p = 0.74), hematoma (RR = 0.75 (95% CI: 0.37-1.52); p = 0.42), or bleeding (RR = 0.54 (95% CI: 0.15-2.02); p = 0.36). NPWT showed no significant effects on readmission (RR = 0.65 (95% CI: 0.37-1.16); p = 0.15), reoperation (RR = 1.27 (95% CI: 0.45-3.58); p = 0.66), or length of hospital stay (MD = -0.32 (95% CI: -0.81 to 0.18); p = 0.21). Trial sequential analysis (TSA) confirmed the robustness of the primary outcome, and sensitivity analyses supported the consistency of results.

CONCLUSIONS

ciNPWT appears effective in reducing SSIs in abdominal surgery, yet its broader clinical value remains uncertain due to inconsistent benefits across secondary outcomes and unresolved heterogeneity. Future studies should focus on standardizing ciNPWT protocols, identifying high-risk subgroups, and evaluating cost-effectiveness, particularly in resource-limited settings.