Negative pressure wound therapy for the prevention of surgical site infections in orthopedic and trauma surgery: a systematic review and meta-analysis of RCTs.

BACKGROUND: Surgical site infections (SSIs) are an important postoperative complication in orthopedic surgery, resulting in increased morbidity, prolonged hospital stay, and higher healthcare costs. Negative pressure wound therapy (NPWT) has been proposed to reduce SSIs by facilitating wound healing by increased perfusion, edema reduction, and bacterial control. This systematic review and meta-analysis evaluate the effectiveness of NPWT compared with conventional dressings for prevention of surgical site infections in orthopedic and trauma surgery. METHODS: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, and the Cochrane Library in December 2024. Only randomized controlled trials (RCTs) comparing NPWT with CD in patients undergoing joint replacement, trauma surgery, or spine surgery were included. Two independent reviewers conducted data extraction and assessed study quality using the Cochrane Risk of Bias 2 tool. Pooled outcomes were evaluated with odds ratios (ORs) computed for dichotomous variables and mean differences (MDs) for continuous outcomes. Heterogeneity was assessed via the I2 statistic and publication bias through Egger's test. RESULTS: Overall, 18 RCTs, comprising a total of 4585 patients, were included. Meta-analysis demonstrated that NPWT significantly reduced SSIs (pooled OR 0.64, 95% CI 0.50-0.82; p = 0.0005) and wound dehiscence (pooled OR 0.39, 95% CI 0.23-0.65; p = 0.0003). Additionally, NPWT was associated with a reduction in length of hospital stay by 0.87 days (MD -0.87, 95% CI -1.36 to -0.38; p = 0.0005) and fewer dressing changes compared with conventional methods. The quality of evidence for the primary outcome was rated as moderate based on the GRADE approach. CONCLUSIONS: NPWT appears to offer a significant clinical benefit in reducing the incidence of SSIs in orthopedic and trauma surgery. Secondary analyses also demonstrated benefits for surgical wound dehiscence, length of hospital stay, and number of dressing changes. However, the certainty of evidence is moderate, and these findings should be interpreted with caution. Further well-designed, multicenter RCTs are warranted to confirm these benefits, assess long-term outcomes, and evaluate cost-effectiveness. Level of evidence Level I. REGISTRATION: CRD42024624188.