The efficacy of negative-pressure wound therapy (NPWT) in the prevention of surgical site occurrences in open abdominal surgery: A randomized clinical trial

Background: The secondary consequences of surgical site occurrences, especially surgical site infections, worsen the patient's outcomes while significantly increasing health care costs. The implementation of preventive measures to reduce this complication rate should be one of the priorities to improve health care.

Methods: A randomized, open-label clinical trial was conducted between March 2019 and March 2021 in a general surgery department. Individuals who had undergone laparotomy and had risk factors for developing surgical site infections and surgical site occurrences were included and randomized to use either negative-pressure wound therapy or conventional dressing (control group) on the closed surgical incision. The aim of our study was to evaluate the benefit of negative-pressure wound therapy in the surgical site infection rates and other surgical site occurrences in both groups at a 30-day follow-up.

Results: Two hundred seventy-five participants were recruited and were analyzed, 147 (53.5%) in the negative-pressure wound therapy group and 128 (46.5%) in the control group. Thirty-one (11.3%) surgical site infections and 71 (25.8%) other surgical site occurrences were observed, being significantly lower in the negative-pressure wound therapy group (odds ratio 0.31, 95% confidence interval 0.14-0.71; P = .005) and (odds ratio 0.51, 95% confidence interval 0.29-0.90; P = .02), respectively. Absolute risk reduction was 13% for surgical site infection and 12% for other surgical site occurrences. Number needed to treat 9 (95% confidence interval 5-29) for surgical site infection and number needed to treat of 8 (95% confidence interval 5-51) for other surgical site occurrences. Median hospital stay was 3 days lower in the negative-pressure wound therapy group than in the control group (9 vs 12 days; P = .03). No severe adverse events attributable to the negative-pressure wound therapy dressing were reported.

Conclusion: Negative-pressure wound therapy decreases the risk of surgical site occurrences and surgical site infection after laparotomy, so that its use should be considered in patients with risk factors.