Effectiveness of negative pressure wound therapy versus conventional dressings in emergency laparotomy: a systematic review and meta-analysis of randomized controlled trials

Background:

Surgical site infections represent a significant complication after emergency laparotomy, contributing to increased morbidity, mortality, and healthcare costs. Negative pressure wound therapy (NPWT) may reduce the incidence of surgical site infections; however, evidence from randomized controlled trials remains inconsistent.

Aims:

To present a systematic review and meta-analysis, comparing NPWT with conventional dressings in emergency laparotomies.

Methods:

Systematic searches were conducted according to the Cochrane Handbook and reported according to the PRISMA 2020 guidelines. The PubMed, Embase, and Cochrane CENTRAL databases were searched since their inception, using terms related to emergency laparotomy, NPWT, and conventional dressings. The reference lists of included studies were manually examined to identify additional eligible trials. Only randomized controlled trials that compared NPWT with conventional dressings in emergency abdominal surgeries and that reported surgical site infection rates or other clinical outcomes were included. The primary outcome was the incidence of surgical site infection. Secondary outcomes included wound dehiscence, seroma formation, length of hospital stay, and 30-day mortality.

Results:

Eight randomized controlled trials, totaling 1,377 patients (707 in the NPWT group and 670 in the conventional dressing group), were included. NPWT significantly reduced the risk of surgical site infection (risk ratio [RR] 0.43; 95% confidence interval [CI] 0.26–0.73; p=0.002; heterogeneity [I2]=76%) and wound dehiscence (RR 0.32; 95%CI 0.18–0.58; p=0.0002). No significant differences were observed regarding seroma formation (RR 0.59; 95%CI 0.34–1.01; p=0.05), length of hospital stay (mean difference [MD] -0.39 days; 95%CI -1.15– 0.36; p=0.92) or mortality (RR 0.96; 95%CI 0.55–1.68; p=0.88).

Conclusions:

This systematic review and meta-analysis of randomized clinical trials suggests that NPWT reduces the incidence of surgical site infection and wound dehiscence after emergency laparotomy, supporting its use in high-risk patients.