The feasibility and safety of prophylactic subcutaneous negative pressure wound therapy after emergency laparotomy: a descriptive, non-comparative cohort study

Abstract Background Surgical site infections (SSI) following major emergency abdominal surgery (MEAS) occur up to 23% of cases, with risk factors including prolonged operative time, wound contamination, high BMI, smoking, and high ASA scores. Prophylactic subcutaneous negative pressure wound therapy (sNPWT) is a novel technique for at-risk wounds and remains understudied in emergency settings. This study assessed feasibility, safety, and surgical site occurrences (SSO) associated with prophylactic sNPWT following high-risk emergency laparotomy. Methods This prospective single-center study included adults undergoing emergency midline laparotomy managed with prophylactic sNPWT between February 2021 and June 2023 at Copenhagen University Hospital, Herlev, Denmark. Primary outcomes were SSO and SSI within 30 postoperative days. Secondary outcomes included time to definitive skin closure, closure success, dressing changes, length of stay (LOS), reoperation, and adverse events. Results Twenty-two patients (68.2% male; median age 68) received prophylactic sNPWT. SSO occurred in 47.6% at 30 days, while SSI occurred in 14.3%. Seroma was most common (33.3%). Median time to skin closure was 5 days (IQR 4.0–7.25), achieved in 95.5% of patients. Median LOS was 17.5 days (IQR 10.75–30.5). One unrelated death (4.5%) & one sNPWT related adverse event (4.5%) was recorded. Five patients (22.7%), including the death, required a Clavien-Dindo grade ≥ 3 reoperation. Conclusion In this descriptive, non-comparative cohort, prophylactic sNPWT for delayed primary closure in high-risk emergency laparotomy appeared feasible, with a high closure rate and an acceptable adverse event profile. These hypothesis-generating findings require confirmation in controlled comparative studies.