Negative-pressure wound therapy in thoracic and abdominal surgery: meta-analysis of randomized trials.

BACKGROUND: Around 30 000 patients undergo emergency laparotomy in the UK each year, and a similar number of patients undergo open cardiothoracic surgery. Surgical site infection is a common complication associated with increased morbidity, prolonged hospital stay, and higher healthcare costs. Negative-pressure wound therapy has been proposed as a prophylactic strategy to reduce wound complications, but trial evidence has been inconsistent. METHODS: This systematic review and meta-analysis was carried out using PRISMA guidelines and was registered prospectively in PROSPERO (CRD420251010516). A literature search was carried out in March 2025 (updated December 2025), and titles and abstracts were screened against predefined inclusion criteria. Trials assessing patients undergoing open thoracic or abdominal surgery for any indication in adult patients assessing the risk of surgical site infection as an outcome were included. Quality assessment was performed using Cochrane's risk-of-bias 2 tool. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval of 95% and are presented as forest plots. RESULTS: Some 12 427 patients across 45 randomized trials in abdominal and thoracic surgery were included for analysis. Negative-pressure wound therapy significantly reduced surgical site infection compared with standard dressings (odds ratio (OR) 0.53, 95% confidence interval 0.42 to 0.66). The effect was consistent across commercial devices (PICO™ and Prevena™). Negative-pressure wound therapy was associated with shorter hospital stay (mean difference -1.67 (95% confidence interval -3.19 to -0.16) days), but not with reduced risk of organ/space infection (OR 0.92, 0.67 to 1.25), wound dehiscence, or reoperation. Only three studies included thoracic surgery and no significant difference in surgical site infection was found (OR 0.44, 0.00 to 45.25). Publication bias was detected; trim-and-fill analysis attenuated but did not eliminate the benefit (adjusted OR 0.70, 0.54 to 0.90). Adverse events and patient-reported outcomes were reported infrequently, and showed no consistent differences. CONCLUSION: Negative-pressure wound therapy 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 is supported.