Negative pressure wound therapy for the prevention of surgical site complications in emergency laparotomies: an updated systematic review and meta-analysis

Surgical site infections (SSIs) are common after emergency laparotomy and are associated with substantial morbidity, prolonged recovery, and increased health care costs. Negative pressure wound therapy (NPWT) has been increasingly used prophylactically on closed incisions in high-risk surgical patients; however, evidence supporting its effectiveness after emergency laparotomy remains heterogeneous. This updated systematic review and meta-analysis aimed to reassess the effectiveness of NPWT compared with standard postoperative dressings for the prevention of SSI and other wound-related complications following emergency laparotomy. A systematic review and meta-analysis was conducted in accordance with the Cochrane Handbook and PRISMA 2020 guidelines. PubMed, Embase, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov were searched for studies published from April 2, 2022, to December 10, 2025, updating a prior review. Randomized clinical trials and comparative observational studies evaluating NPWT versus standard dressings in adult patients undergoing emergency laparotomy were included. The primary outcome was SSI. Secondary outcomes included superficial and deep SSI, wound dehiscence, seroma, hematoma, and length of hospital stay. Random-effects meta-analyses were performed. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was evaluated with GRADE. Twenty-three studies involving 5371 patients were included, of whom 2528 received NPWT. NPWT was associated with a significantly lower risk of SSI compared with standard dressings (risk ratio, 0.53; 95% CI 0.41–0.68), with moderate to substantial heterogeneity (I² = 68%). NPWT was also associated with reductions in superficial and deep SSI, seroma formation, and wound dehiscence, but not with organ/space SSI, hematoma, or length of hospital stay. Sensitivity and subgroup analyses demonstrated consistent direction of effect. Funnel plot asymmetry and a significant Egger test suggested small-study effects. Among patients undergoing emergency laparotomy, prophylactic NPWT applied to closed incisions was associated with a lower risk of SSI and several wound-related complications compared with standard postoperative dressings. However, the certainty of evidence remains very low due to heterogeneity, risk of bias, and small-study effects, highlighting the need for large pragmatic multicenter randomized trials to better define the magnitude of benefit and optimal patient selection.