Prophylactic Negative-Pressure Wound Therapy Reduces Surgical Site Infection After Major Abdominal Surgery : BJS Open | May 2026

Introduction

Surgical Site Infection remains one of the most common complications after major abdominal and thoracic surgery, contributing substantially to postoperative morbidity, prolonged hospitalization, reintervention and healthcare expenditure. High-risk procedures such as emergency laparotomy and open cardiothoracic surgery are particularly vulnerable to wound complications. Prophylactic Negative-Pressure Wound Therapy has emerged as a potential strategy to reduce postoperative wound morbidity, although prior clinical trial results have been inconsistent.

Problem Statement

The effectiveness of prophylactic negative-pressure wound therapy in reducing surgical site infection and improving postoperative outcomes after major thoracic and abdominal surgery remains uncertain because of heterogeneous trial data and variable study quality.

Summary

This systematic review and meta-analysis evaluated randomized trials investigating prophylactic negative-pressure wound therapy following open abdominal and thoracic surgery, providing one of the largest contemporary syntheses of evidence in this field.

Across more than 12,000 patients from 45 randomized trials, negative-pressure wound therapy significantly reduced the incidence of surgical site infection compared with standard dressings. The magnitude of benefit was substantial, with approximately a 50% relative reduction in infection risk observed overall.

Importantly, the beneficial effect appeared consistent across commonly used commercial systems, suggesting that the therapeutic principle rather than a specific proprietary device likely underlies the observed reduction in wound complications.

Negative-pressure therapy was additionally associated with shorter hospital stay, reinforcing the broader clinical and economic relevance of reducing postoperative wound morbidity. Even modest reductions in length of stay may translate into major cumulative healthcare savings at a population level, particularly in high-volume abdominal surgery pathways.

However, the analysis also demonstrated important limitations. Negative-pressure wound therapy did not significantly reduce organ-space infection, wound dehiscence or reoperation rates. This suggests that the primary benefit is likely confined predominantly to superficial or deep incisional wound complications rather than broader intra-abdominal septic processes.

The thoracic surgery evidence base remained notably limited, with only three studies included and no statistically significant reduction in infection demonstrated in this subgroup. Consequently, extrapolation of abdominal surgery findings to thoracic procedures should be performed cautiously.

A particularly important methodological observation was the detection of publication bias. After statistical correction using trim-and-fill analysis, the magnitude of benefit was attenuated though still remained significant. This finding suggests that earlier enthusiasm regarding prophylactic negative-pressure therapy may partly overestimate the true effect size.

The study therefore supports a more nuanced clinical approach rather than universal adoption. Selective use in high-risk patients appears most justifiable, particularly in individuals with obesity, diabetes, contaminated surgery, immunosuppression, emergency laparotomy or other established wound-healing risk factors.

The findings also reflect the growing emphasis on perioperative optimization and complication prevention within modern surgical practice. Reducing surgical site infection not only improves immediate postoperative recovery but may also influence downstream oncologic treatment timelines, readmissions and patient quality of life.

Importantly, the authors highlight persistent deficiencies in reporting patient-reported outcomes and long-term wound-related endpoints. Future studies will need to better evaluate pain, mobility, scar quality, device tolerance and cost-effectiveness to fully define the clinical value of prophylactic negative-pressure systems.

From a mechanistic standpoint, negative-pressure therapy likely improves wound healing through multiple pathways including reduction of dead space, fluid removal, enhanced perfusion and stabilization of the incision environment. However, the relative contribution of these mechanisms in closed surgical incisions remains incompletely understood.

Overall, this large meta-analysis supports prophylactic negative-pressure wound therapy as an effective strategy for reducing surgical site infection and shortening hospital stay after major abdominal surgery. Nevertheless, evidence of publication bias and limited long-term outcome data support a selective risk-based implementation strategy rather than routine universal use across all surgical populations.