Incisional Negative Pressure Wound Therapy Reduces Surgical Site Infection: JAMA Surgery | August 2026

Introduction:

Surgical site infection (SSI) remains a major cause of postoperative morbidity despite modern prevention bundles. Incisional negative pressure wound therapy (iNPWT) applied over a primarily closed incision has emerged as a nonantibiotic strategy to improve wound healing. This large meta-analysis evaluated its benefits and harms compared with standard dressings.

Why was this study needed?

Previous studies suggested reduced SSI with iNPWT but results varied across surgical specialties.

Its effect on superficial versus deep infection remained uncertain.

Device-related complications, particularly skin injury, required better quantification.

Clear evidence was needed to determine whether iNPWT should be used routinely or selectively.

Results:

Across 85 randomized trials involving 16,980 patients, iNPWT reduced overall SSI by approximately 36%, with benefit for both superficial and deep infections.

It also reduced wound dehiscence, seroma, skin necrosis, and reoperation, but did not significantly reduce organ-space infection, readmission, or mortality.

The number needed to treat was 21 to prevent one SSI.

However, skin blistering and device-related adverse events increased; approximately 1 additional blistering event occurred for every 18 patients treated.

Clinical Impact:

The evidence supports iNPWT as an effective targeted SSI-prevention strategy, particularly for patients with a high baseline risk of wound complications. However, the relatively frequent device-related skin complications mean that routine application to every closed surgical incision is unlikely to provide an optimal benefit–harm balance.

Bottom Line:

Incisional negative pressure therapy reduces superficial and deep surgical site infections and several wound complications, but increases skin blistering and device-related adverse events. The key message is selective use: prioritize iNPWT for high-risk wounds and high-risk patients rather than applying it routinely after all surgery.