Negative-Pressure Wound Therapy for Surgical Site Infection Prevention After Elective Open Abdominal Surgery: A Risk-Stratified Systematic Review and Meta-Analysis of Randomized Controlled Trials
In brief
Negative-pressure dressings cut abdominal wound infections by about 7 percentage points
Across 15 randomized trials, infections occurred in 12.6% of patients given negative-pressure wound therapy, versus 19.5% with standard dressings - about 7 fewer infections per 100 patients. The low-certainty overall benefit was concentrated in high-risk patients and lower-income-country trials; high-income multicenter trials found no benefit, so routine use is not supported.
- Journal
- The Journal of hospital infection (Q1)
- Published
- 30 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ibrahim Moqbel, Ahmad Omar Saleh, Ahmed Shawky, Enas Ewais, Mohammad A Zaied, Shaheel Mohammad Sahebally, et al.
- PMID
- 42963003
- DOI
- 10.1016/j.jhin.2026.10.026
Why clinicians should know about it
- Picked for Surgery (top studies of the week, 1 November 2026): Meta-analysis of randomized trials on abdominal surgical-site infection prevention
Abstract
BACKGROUND: Surgical-site infection (SSI) is a major source of morbidity after elective open abdominal surgery. Prophylactic negative-pressure wound therapy (NPWT) may reduce SSI, but evidence specific to elective surgery remains limited. METHODS: PubMed, Embase, CENTRAL, Scopus, and Web of Science were searched through June 2026 for RCTs comparing prophylactic NPWT with standard wound dressing (SWD) in adults undergoing elective open abdominal surgery. The prespecified primary outcome was overall SSI within 30 days. Random-effects (REML) meta-analysis generated risk ratios or mean differences with 95% confidence and prediction intervals; certainty was assessed using GRADE. RESULTS: Sixteen RCTs (2 639 patients) were included; 13 were at low risk of bias. NPWT reduced overall SSI (15 RCTs, 2 134 patients; RR 0.60, 95% CI 0.43-0.84; low certainty; absolute risk 12.6% vs 19.5%, approximately 7% reduction; NNT≈15), superficial SSI (RR 0.58, 95% CI 0.35-0.98), and seroma (RR 0.57, 95% CI 0.38-0.86; both high certainty). No significant differences were observed in deep SSI, hematoma, dehiscence, readmission, length of stay, blood loss, operative time, or mortality. Benefit was concentrated in lower-income-country trials and high-risk patients, whereas high-income multicenter trials showed no benefit. Prediction intervals crossed the null, and funnel asymmetry suggested possible publication bias. CONCLUSIONS: NPWT may reduce overall SSI, superficial SSI, and seroma after elective open abdominal surgery, but effects appear context-dependent and were absent in the highest-quality multicenter trials. Routine use in unselected elective patients is not supported; selective use in high-risk patients may be appropriate, pending confirmatory trials such as PROPEL-2.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.