Incisional Negative Pressure Wound Therapy for Prevention of Surgical Site Infection
Shaan Patel, Shiva A. Nischal, Kush M. Kale, Akash Dubb, Srinivas K. Prasad, Daniel RefaiImportance
Incisional negative pressure wound therapy (iNPWT) has been proposed as a nonantibiotic adjunct to standard dressings for preventing surgical site infection (SSI), but uncertainty remains regarding consistency across SSI subtypes and dressing-related harms.
Objective
To evaluate the efficacy and safety of iNPWT vs standard dressing in adults undergoing surgery.
Data Sources
PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception through March 7, 2026.
Study Selection
Randomized clinical trials (RCTs) enrolling adults in whom iNPWT was applied to primarily closed surgical incisions and compared with standard dressing.
Data Extraction and Synthesis
Two reviewers independently extracted data. Risk ratios (RRs) and mean differences with 95% CIs were pooled using random-effects models.
Main Outcomes and Measures
The primary outcome was overall SSI. Secondary outcomes included SSI subtypes, wound dehiscence, seroma, skin necrosis, reoperation, readmission, mortality, skin blistering, and device-related adverse events.
Results
Eighty-five RCTs comprising 16 980 patients (iNPWT, n = 8463; standard dressing, n = 8517) were included. The mean (SD) age was 48.3 (19.4) years (48.1 [19.5] years in the iNPWT group and 48.5 [19.4] years in the standard dressing group), and 5660 of 16 075 individuals (35.2%) were male (2889 [35.7%] in the iNPWT group and 2771 [34.7%] in the standard dressing group). iNPWT was associated with lower risk of overall SSI (RR, 0.64; 95% CI, 0.57-0.72), deep SSI (RR, 0.66; 95% CI, 0.51-0.86), superficial SSI (RR, 0.59; 95% CI, 0.49-0.72), wound dehiscence (RR, 0.73; 95% CI, 0.61-0.88), seroma (RR, 0.77; 95% CI, 0.63-0.94), reoperation (RR, 0.80; 95% CI, 0.64-0.99), and skin necrosis (RR, 0.38; 95% CI, 0.18-0.80). No significant differences were observed for organ-space SSI, readmission, or mortality. iNPWT was associated with higher risks of skin blistering (RR, 4.51; 95% CI, 2.37-8.58) and device-related adverse events (RR, 11.87; 95% CI, 4.74-29.74). The number needed to treat was 21 for SSI; the number needed to harm was 18 for skin blistering and 11 for device-related adverse events. Trial sequential analysis confirmed evidence for overall, deep, and superficial SSI. Certainty of evidence was moderate.
Conclusions and Relevance
In this systematic review and meta-analysis of 85 RCTs, iNPWT was associated with lower risks of overall, deep, and superficial SSI and several wound complications but potentially higher risks of skin blistering and device-related adverse events. These findings support selective rather than routine use, particularly in patients at elevated risk of incisional wound complications.