The impact of negative pressure wound therapy on surgical site infection rates in obese women following cesarean section: A systematic review and meta-analysis

Background & Aim: This study aims to assess the surgical site infection (SSI) rate in obese women undergoing C-sections, comparing negative pressure wound therapy (NPWT) and standard dressings. Methods & Materials: In this systematic review and meta-analysis, databases including Science Direct, Medline/PubMed, Web of Science, Scopus, and Cochrane Library were searched for articles published up to January 2024. The selection criteria included randomized controlled trials and cohort studies comparing the effect of (NPWT) with standard dressings on wound complications in women with obesity undergoing C-sections. Data collection and analysis Pooled effect sizes were calculated using random effects models based on heterogeneity. Results: Out of 20 included studies, 18 reported SSI rates, which included 9243 cases and showed that NPWT reduces the rate of SSIs in obese women undergoing C-section (RR: 0.8, 95% CI: 0.66-0.96, I2= 24.5%, P= 0.01). An in-depth examination of 13 high-quality studies, in which NPWT devices were used, reveals a pooled Mantel-Haenszel (M-H) Risk Ratio (RR) of 0.92 for Prevention- Reduction - Epithelialization- Vacuum- Environment- Negative pressure- Advanced (PREVENA) (95% CI: 0.67-1.26, I2= 0%, P= 0.6) and 0.76 for PressureIncision- Closed- Optimization (PICO) (95% CI: 0.44-1.33, I2= 15%, P= 0.05), with a significant difference among devices (P=0.05). Conclusion: NPWT reduces the SSI rate in obese women undergoing C-sections, regardless of the type or device used. Economic evaluations are crucial to justify NPWT device costs against expenses for treating surgical infections, supporting its widespread use in infection prevention.