Protective Effect of Prophylactic Negative-Pressure Wound Therapy on Surgical-Site Infection in High-Risk Open Abdominal Surgery: A Retrospective Cohort Study and Nomogram Development

Abstract

Surgical-site infections (SSIs) are a major complication after open abdominal surgery, especially in high-risk patients (obesity, diabetes, immunosuppression). Prophylactic negative-pressure wound therapy (pNPWT) may reduce SSIs. This study evaluated pNPWT versus standard dressings and developed an SSI risk prediction nomogram. A single-centre retrospective study included 83 high-risk adults undergoing open abdominal surgery (2022–2024). Patients received pNPWT (n = 38, −125 mmHg for 5–7 days) or standard dressing (n = 45). Primary outcome: CDC-classified SSI within 30 days. Secondary outcomes included wound dehiscence, epithelialisation time, hospital stay, 30-day readmission and 3-month scar quality. Multivariate logistic regression identified SSI predictors; a nomogram was built and assessed (discrimination: AUC, calibration: bootstrap, utility: decision curve). SSI incidence was significantly lower with pNPWT (5.3% vs. 35.6%; p = 0.002). Compared with standard dressings, pNPWT shortened time to complete epithelialization (10.2 [8.90–11.4] vs. 14.5 [12.3–17.7] days; p < 0.001) and reduced postoperative length of stay (10.3 [8.88–12.2] vs. 13.4 [10.5–17.4] days; p < 0.001). In multivariable analysis, pNPWT was independently protective (adjusted OR: 0.030, 95% CI: 0.001–0.298; p = 0.011), while higher BMI (adjusted OR: 1.476; p = 0.013), higher HbA1c (adjusted OR: 3.726; p = 0.016) and longer incision length (adjusted OR: 1.441; p = 0.016) were associated with increased SSI risk. pNPWT significantly reduces SSIs and improves wound healing in high-risk open abdominal surgery. The developed nomogram accurately predicts individual SSI risk, aiding personalised prophylaxis. Prospective multi-centre RCTs with economic evaluations are needed to confirm findings and guide practice.