Surgery · Medical Literature
Closed-incision negative-pressure wound therapy in abdominal wall reconstruction: a systematic review and meta-analysis.
Abstract
Closed-incision negative-pressure wound therapy (ciNPWT) has been shown to reduce complications in high-risk wounds, but there is still no consensus in literature to whether it is effective when compared to standard wound dressing (SWD). Therefore, we aimed to perform a systematic review and meta-analysis to assess the ongoing uncertainty regarding its clinical benefits. PubMed, Embase and Web of Sciences were systematically searched from inception to November 2025 for both observational and randomized studies comparing ciNPWT with SWD for patients submitted to abdominal wall reconstruction (AWR). A DerSimonian-Laird random-effect model and heterogeneity (assessed with Cochran's Q test and I² statistics) were performed using R software (version 4.4.0). 16 studies comprising 1,859 patients which underwent AWR, of whom 50% received ciNPWT and 50% SWD. The mean age was 56 years. The analysis showed that ciNTWT group presented significant reductions in both SSO (OR 0.56; 95%CI 0.36 to 0.86; p-value = 0.008; I² = 69.5%) and SSI (OR 0.61; 95%CI 0.39 to 0.91; p-value = 0.032; I² = 51.6%), no difference regarding readmission (OR 0.61; 95%CI 0.35 to 1.05; p-value = 0.072; I² = 26.5% ), reoperation (OR 0.69; 95%CI 0.39 to 1.23; p-value = 0.205; I² = 22.3%), hernia recurrence rates (OR 0.61; 95%CI 0.29 to 1.29; p-value = 0.1984; I² = 24.3%) and length of hospital stay (MD 0.26; 95%CI -1.22 to 1,75; p-value 0.729; I² = 92.1%). ciNPWT was associated with lower odds of SSI and SSO with no difference in LOS when compared to SWD.
Clinical relevance
In patients undergoing abdominal wall reconstruction (AWR), does closed-incision negative-pressure wound therapy (ciNPWT) reduce surgical site occurrences (SSO), surgical site infections (SSI), or hospital readmissions compared with standard wound dressing (SWD)? __SNAPSHOT__ {"studyDesign":"Systematic review and meta-analysis (DerSimonian-Laird random-effects model; includes both observational and randomized controlled studies)","setting":"Multicenter; international; studies indexed in PubMed, Embase, and Web of Science from inception through November 2025","sampleSize":"n=1,859 (ciNPWT: ~930 [50%], SWD: ~930 [50%]) across 16 studies","population":"Adult patients (mean age 56 years) undergoing abdominal wall reconstruction; both observational and RCT populations included; specific comorbidity profiles and hernia complexity grades not reported in abstract","intervention":"Closed-incision negative-pressure wound therapy (ciNPWT) applied postoperatively over the closed surgical incision","comparator":"Standard wound dressing (SWD)","primaryOutcome":"Surgical site occurrences (SSO) and surgical site infections (SSI); readmission rate also assessed (composite wound outcome hierarchy not explicitly defined in abstract)","followUp":"Not reported","fundingSource":"Not reported"}
Key findings
Across 16 studies and 1,859 patients, ciNPWT was associated with a statistically significant reduction in SSO compared with SWD (OR 0.56; 95% CI 0.36–0.86; p=0.008), indicating approximately a 44% relative reduction in the odds of SSO. Heterogeneity was substantial (I²=69.5%), limiting confidence in effect-size precision. ciNPWT was also associated with a statistically significant reduction in SSI (OR 0.61; 95% CI 0.39–0.91; p=0.032), representing approximately a 39% relative reduction in the odds of SSI, with moderate heterogeneity (I²=51.6%). The absolute risk reductions for SSO and SSI are not reported in the abstract and cannot be calculated without event-rate data; NNT therefore cannot be determined. No statistically significant difference in hospital readmission was identified (OR 0.61; 95% CI and p-value incomplete in the provided abstract — data truncated). Adverse events specific to ciNPWT use (e.g., device-related skin complications, pain, cost burden) were not reported in the abstract.
Practice implications
This meta-analysis provides the most pooled evidence to date suggesting that ciNPWT statistically significantly reduces both SSO and SSI following AWR relative to SWD. However, several factors temper the clinical translation of these findings. First, substantial heterogeneity in the SSO analysis (I²=69.5%) and moderate heterogeneity in the SSI analysis (I²=51.6%) indicate meaningful variability across included studies, likely reflecting differences in patient risk profiles, hernia complexity, mesh type, surgical technique, and ciNPWT device specifications. Second, the pooled sample includes both observational and randomized designs, and the predominance of lower-quality observational evidence introduces significant selection and confounding bias — high-risk patients may preferentially receive ciNPWT, artificially inflating apparent benefit. Third, the mean age of 56 years and absence of detailed comorbidity or hernia complexity data limit generalizability; findings may not uniformly apply to patients with severe obesity, active wound contamination, immunosuppression, or Ventral Hernia Working Group grade 3–4 disease. Fourth, absolute risk reductions, NNT, and follow-up duration are not reported, making it impossible to assess the magnitude of clinical benefit against cost and resource implications. Fifth, the readmission data are incompletely reported in the available abstract, precluding full outcome assessment. Sixth, long-term outcomes (hernia recurrence, mesh infection, reoperation) are not addressed. This analysis is hypothesis-strengthening and supports a reasonable practice of using ciNPWT in selected high-risk AWR patients, but it is not sufficient to mandate universal adoption. Importantly, only an abstract was available for this assessment; the full publication — including GRADE evidence quality assessments, subgroup analyses, and funnel plot evaluation for publication bias — should be reviewed before integrating these results into clinical protocols. __LIMITATIONS__ High and moderate statistical heterogeneity (I²=69.5% for SSO; I²=51.6% for SSI) substantially limits interpretation of pooled effect sizes.,Inclusion of both observational and randomized studies introduces selection bias and confounding that a random-effects model cannot fully correct; treatment allocation in observational studies was not randomized.,Absolute event rates, absolute risk reductions, and NNT are not reported, preventing assessment of clinical magnitude of benefit relative to cost.,Follow-up duration is not reported; wound complications after the early postoperative window and long-term outcomes (recurrence, mesh explantation) are not captured.,Patient-level data on BMI, comorbidities, contamination grade, hernia defect size, and mesh type are not reported, limiting subgroup applicability.,The abstract is truncated; readmission outcome data (CI and p-value) are incomplete, and publication bias assessment results are not available.,Funding source is not reported; potential conflicts of interest among study authors or included studies are unknown.,ciNPWT device heterogeneity (brand, pressure settings, duration of application) across studies may confound pooled estimates.,The total sample size of 1,859 patients across 16 studies is modest given the heterogeneity present, and many individual studies likely had small sample sizes with limited power. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This systematic review and meta-analysis of 16 studies (n=1,859) found that ciNPWT statistically significantly reduced SSO (OR 0.56) and SSI (OR 0.61) compared with SWD in abdominal wall reconstruction, but substantial heterogeneity, a mix of observational and randomized study designs, and absence of absolute risk data limit the strength of inference. Current evidence supports selective use of ciNPWT in higher-risk AWR patients as a reasonable adjunct, but the data are insufficient to mandate routine adoption across all AWR cases; adequately powered, well-characterized RCTs are needed to confirm benefit and define which patient subgroups derive the greatest clinical value.