SRS384 - Negative pressure wound therapy in patients undergoing open thoracic and abdominal surgery: a systematic review and meta-analysis of randomised trials

Abstract Background Surgical site infection (SSI) is a common complication following major thoracic and abdominal surgery, associated with increased morbidity, prolonged hospitalisation, and is costly. Negative pressure wound therapy (NPWT) has been proposed as a prophylactic strategy to reduce wound complications, but trial evidence has been inconsistent. Methods This meta-analysis was carried out using the Preferred Reporting Items in Systematic Reviews and Meta-Analysis (PRISMA). A literature search was carried out March 2025, and titles/abstracts screened against our pre-defined inclusion criteria. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval (c.i.) of 95% and are presented as Forest Plots for Odds Ratio (OR) or mean difference (MD). Results 12 157 patients across 42 randomised trials in abdominal and thoracic surgery were included for analysis. NPWT significantly reduced SSI compared with standard dressings (OR = 0.54; 95% c.i.:0.43–0.69). The effect was consistent across commercial devices (PICO™and Prevena™). NPWT was associated with shorter length of hospital stay (MD = –1.21 days; 95% c.i., –1.61 to –0.80) but not with reduced risk of organ/space infection, wound dehiscence, or reoperation. Publication bias was detected; trim-and-fill analysis attenuated but did not eliminate the benefit (adjusted OR = 0.73; 95% c.i.:0.54–0.98). Discussion NPWT was associated with a nearly 50% reduction in SSI and shorter hospital stay after open abdominal surgery, with consistent benefit across device types. However, evidence of publication bias and limited long-term and patient-reported outcome data suggest that effect size may be overestimated. Selective use in high-risk patients and further investigator-led pragmatic trials are warranted.