412 Negative Pressure Wound Therapy in Patients Undergoing Open Thoracic and Abdominal Surgery: A Systematic Review and Meta-Analysis of Randomised Trials

Abstract Aim Around 30,000 patients undergo emergency laparotomy in the United Kingdom each year, and a similar number of patients undergo open thoracic surgery. These incisions provide surgical access for major thoracic and abdominal surgery, such as oesophagectomy, or pancreaticoduodenectomy. Closure of these wounds may be aided by the use of negative pressure wound therapy (NPWT). Theoretically, this technology aims to reduce wound complications. This systematic review and meta-analysis aims to assess the benefit of NPWT in patients undergoing major open thoracic/abdominal surgery. Method A literature search of was carried out in March 2025, and titles and abstracts were screened against our pre-defined inclusion criteria. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval (CI) of 95% and are presented as Forest Plots for Odds Ratio (OR) or mean difference (MD). Results 13,320 patients across 46 randomised trials in abdominal/thoracic surgery were included for analysis. When limited to abdominal surgery, negative pressure wound therapy reduces surgical site infections (OR=0.51, 95%CI:0.41-0.63). Length of hospital stay was shorter in patients receiving NPWT (MD=-1.21 days, 95%CI:-1.61 - -0.80). Sub-group analyses limited to only PICO or only Prevena-type NPWT showed that both reduced SSI. There was no difference in organ/space infection, fascial dehiscence or re-operation. Conclusions There appears to be benefit to use of NPWT in patients undergoing major open abdominal surgery, in either the emergency or elective setting, for the prevention of SSI. Clinically relevant wound complications such as fascial dehiscence, return to theatre, or organ/deep infection were similar across both groups.