Incisional negative pressure wound therapy after inguinal vascular surgery is associated with reduction in SSI and mortality: systematic review and meta-analysis.

BACKGROUND

Surgical site infections (SSI) are common after inguinal vascular surgery, affecting up to 44% of patients, with substantial increases in morbidity, mortality and cost. Although perioperative antibiotics reduce SSI, the benefit of adjunctive measures remains uncertain. Incisional negative pressure wound therapy (NPWT) has been proposed to decrease the risk of SSI, but its efficacy, particularly against severe infections, remains unclear.

METHODS

PubMed, Scopus, Web of Science and Embase were searched for randomized and cohort studies published between 2005 and 2025 that compared NPWT with standard wound care in inguinal vascular surgery. The primary outcome was SSI defined by the Centers for Disease Control and Prevention criteria or the Szilagyi classification. The secondary outcomes included complications, mortality, reoperation, readmission, operative time, and hospital stay. Risk of bias was evaluated using the ROBINS-I and Risk of Bias 2 tools. Pooled estimates were calculated using random-effects models; heterogeneity was evaluated by χ2 and I2 statistics.

RESULTS

Twenty-one full-text studies and one conference abstract (total 4125 patients) were included in this review. NPWT significantly reduced overall SSI [risk ratio (RR) 0.52, 95% confidence interval (CI) 0.42-0.64; P<0.001], total complications (RR 0.68, 95% CI 0.57-0.81; P<0.001), mortality (RR 0.48, 95% CI 0.30-0.77; P=0.002), and seroma/lymphatic events (odds ratio 0.58, 95% CI 0.38-0.91; P=0.02) with low-to-moderate heterogeneity. The benefit of NPWT was greatest in bilateral incisions. No significant differences were observed for haematomas, wound dehiscence, amputations, operative time, length of stay, reoperation or readmission.

CONCLUSIONS

NPWT significantly reduces superficial and overall SSI, complications and mortality after inguinal vascular surgery, particularly in bilateral procedures. Evidence for the prevention of deep infection is limited, and further high-quality randomized trials are required to optimize patient selection and implementation.