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Introduction Negative pressure wound therapy (NPWT) may prevent subcutaneous fluid accumulation in a closed wound and subsequently reduce surgical site infections (SSI). This meta-analysis aimed to determine the effect of prophylactic NPWT on SSI incidence following abdominal surgery. Methods A systematic search of MEDLINE and EMBASE databases was performed using PRISMA methodology. All randomised trials reporting the use of NPWT in closed abdominal incisions were included, regardless of the type of operation. The primary outcome measure was the incidence of SSI, stratified by superficial and deep and organ/ space infections. Secondary outcomes were wound dehiscence and length of hospital stay. Results Ten randomised trials met the inclusion criteria (five Caesarean, five midline laparotomy). The use of NPWT reduced overall SSI (11.6% vs. 16.7%, RR 0.67, 95% CI 0.48-0.95, p = 0.02). The rate of superficial SSI rate was also reduced (6.3% vs. 11.3%, RR 0.57, 95% CI 0.35-0.94, p = 0.03). There was no effect on deep or organ/space SSI (3.2% vs. 4.2%, RR 0.77, 95% CI 0.51-1.18, p = 0.23), wound dehiscence (9.7% vs. 10.9%, RR 0.92, 95% CI 0.69-1.21, p = 0.54), or length of hospital stay (MD 0.06 days, 95% CI-0.11 to 0.23, p = 0.51). Conclusions Prophylactic use of NPWT may reduce the incidence of superficial SSI in closed abdominal incisions but has no effect on deep or organ space SSI.

Background Venous thromboembolism (VTE) and bleeding are serious and potentially fatal complications of surgical procedures. Pharmacological thromboprophylaxis decreases the risk of VTE but increases the risk of major post-operative bleeding. The decision to use pharmacologic prophylaxis therefore represents a trade-off that critically depends on the incidence of VTE and bleeding in the absence of prophylaxis. These baseline risks vary widely between procedures, but their magnitude is uncertain. Systematic reviews addressing baseline risks are scarce, needed, and require innovations in methodology. Indeed, systematic summaries of these baseline risk estimates exist neither in general nor gynecologic surgery. We will fill this knowledge gap by performing a series of systematic reviews and meta-analyses of the procedure-specific and patient risk factor stratified risk estimates in general and gynecologic surgeries. Methods We will perform comprehensive literature searches for observational studies in general and gynecologic surgery reporting symptomatic VTE or bleeding estimates. Pairs of methodologically trained reviewers will independently assess the studies for eligibility, evaluate the risk of bias by using an instrument developed for this review, and extract data. We will perform meta-analyses and modeling studies to adjust the reported risk estimates for the use of thromboprophylaxis and length of follow up. We will derive the estimates of risk from the median estimates of studies rated at the lowest risk of bias. The primary outcomes are the risk estimates of symptomatic VTE and major bleeding at 4 weeks post-operatively for each procedure stratified by patient risk factors. We will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate evidence certainty. Discussion This series of systematic reviews, modeling studies, and meta-analyses will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding in general and gynecologic surgeries. Our work advances the standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at the best estimates of risk (including modeling of the timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the GRADE approach. Systematic review registration PROSPERO CRD42021234119