Effect of Prophylactic Incisional Negative Pressure Wound Therapy on Surgical Site Infection After Emergency Laparotomy: An Updated Meta-Analysis With Trial Sequential Analysis.

INTRODUCTION: Patients undergoing emergency laparotomy are at high risk of surgical site infections (SSI), which contribute substantially to postoperative morbidity. Incisional negative pressure wound therapy (iNPWT) has been shown to reduce the incidence of SSI following elective surgery, however, its effectiveness in the emergency setting remains uncertain. Therefore, we conducted a systematic review and meta-analysis to evaluate the effectiveness of iNPWT in reducing SSI after emergency laparotomy. METHODS: We searched PubMed, Embase, and Cochrane through November 2025 for randomized controlled trials (RCTs) and observational studies comparing iNPWT to standard dressings after emergency laparotomy. Odds ratios (OR) and mean differences (MD) were pooled for relevant outcomes with 95% confidence intervals using random-effects and inverse variance weighting. A two-tailed p-value < 0.05 was considered significant. Prespecified subgroup analyses restricted to RCTs were performed. Statistical heterogeneity was assessed using the I2 statistic. RESULTS: Fifteen studies (6 RCTs and 9 observational) including 3369 patients were analyzed. It was found that iNPWT was associated with significantly lower odds of overall (OR 0.36; p = 0.0003), superficial, and deep SSI, with consistent findings in RCT-only analysis (OR 0.41; p = 0.0221). iNPWT was also associated with lower odds of seroma (OR 0.57; p = 0.0325), with consistent results observed in RCT-only analyses (OR 0.54; p = 0.025). Hospital length of stay was shorter in the iNPWT group (MD -1.49 days; p = 0.04), and iNPWT was associated with lower odds of wound dehiscence (OR 0.47; p = 0.0062), however, these findings were not confirmed in RCT-only analyses. Postoperative complications, classified according to the Clavien-Dindo system, did not differ between groups (OR 0.93; p = 0.4973). Overall mortality was comparable between groups, although iNPWT was associated with higher follow-up mortality. This finding was not confirmed in RCTs. CONCLUSION: In patients undergoing emergency laparotomy, iNPWT was associated with reduced odds of SSI and wound-related complications compared with standard dressings. Although iNPWT was associated with higher follow-up mortality, this finding was not confirmed in RCT-only analyses.