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Table 4 Negative wound dressing in preventing SSI: characteristics of the studies included in the review [85,86,87,88,89,96]. SSI surgical site infection, RCT randomized controlled trial, GoR grade of recommendation, NPWT negative-pressure wound therapy, LOS lengh of hospital stay

From: Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines

Author and year of publication

Type of study

Number of patients



Sandy-Hodgetts K et al. (2015) [88]

Systematic review and meta-analysis of 8 (RCT, pseudo-randomized trials, quasi-experimental studies, prospective and retrospective cohort studies, case control studies, and analytical cross sectional studies)


NPWT in preference to standard postoperative dressings may be considered for closed surgical incisions in adults assessed as high-risk for SSI; further research is needed (level 1 studies—RCT) on patients identified as “at risk” in the preoperative period.


Strugala V et al. 2017 [89]

Meta-analysis of 10 RCT + 6 prospective observational trials


The significant reduction in SSI, wound dehiscence, and LOS on the basis of pooled data shows a benefit of the PICO single-use NPWT system compared with standard care in closed surgical incisions.


Sahebally SM et al. 2018 [90]

Systematic review and meta-analysis of 9 studies (3 RCT and 2 prospective and 4 retrospective studies)


Application of NPWT on closed laparotomy wounds in general and colorectal surgery is associated with reduced SSI rates but similar rates of seroma and wound dehiscence compared with conventional nonpressure dressings.


Webster J et al. 2019 [94]

Cochrain systematic review (30 interventional studies)


uncertainty remains about whether NPWT compared with a standard dressing reduces or increases the incidence of important outcomes such as mortality, dehiscence, seroma, or if it increases costs. Given the cost and widespread use of NPWT for SSI prophylaxis, there is an urgent need for larger, well-designed and well-conducted trials to evaluate the effects of newer NPWT products designed for use on clean, closed surgical incisions. Such trials should initially focus on wounds that may be difficult to heal, such as sternal wounds or incisions on obese patients.


Katsuki Danno et al. 2018 [95]

Prospective study


The use of NPWT is an effective measure for preventing SSI in patients undergoing abdominal surgery for peritonitis caused by lower-gastrointestinal perforation.


Lozano-Balderas G et al. 2017 [96]

Prospective randomized study


Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups (primary closure and delayed primary closure). The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17% with primary and delayed primary closures, respectively, to 0% with vacuum-assisted systems.