Routine incisional negative pressure wound therapy fails to reduce SSIs in adults undergoing emergency laparotomy: JAMA
According to a new study researchers have found that routine incisional negative pressure wound therapy (iNPWT) does not significantly reduce surgical site infections (SSIs) more than standard wound dressings in patients undergoing emergency laparotomy with primary skin closure. The study was conducted by the SUNRRISE trial study group published in the journal of JAMA.
SSI is still a significant concern after emergency abdominal surgeries, potentially increasing morbidity and healthcare costs for patients.However, evidence of its effectiveness in reducing the incidence of SSI in emergency laparotomies is deficient. Therefore, this study aimed to assess whether iNPWT reduces the rates of SSIs and improves outcomes following surgery for such a high-risk population.
The SUNRRISE trial was a phase 3, assessor-masked, pragmatic, randomized clinical trial conducted between December 18, 2018, and May 25, 2021. A total of 840 adult patients undergoing emergency laparotomy in 22 UK hospitals and 12 Australian hospitals were enrolled. Participants were randomized 1:1 to receive either iNPWT (n=411) or the surgeon's choice of standard wound dressing (n=410).
The main outcome was SSI at 30 days after surgery, which was evaluated by assessors blinded to the groups by US Centers for Disease Control and Prevention criteria. Secondary outcomes were readmission to hospital, length of stay in hospital, wound pain, quality of life, and postoperative complications.
Results
• A total of 840 patients were enrolled; 394 participants per group were included in the primary analysis after post randomization exclusions.
• SSI rates were similar between the two groups: 112 of 394 patients (28.4%) in the iNPWT group and 108 of 394 (27.4%) in the surgeon's preference group (relative risk: 1.03; 95% CI, 0.83-1.28; p=0.78).
• No significant differences were found in six of the seven secondary outcomes, including hospital readmissions, quality of life, and length of hospital stay (median: 8 days in the iNPWT group vs. 9 days in the standard dressing group; p=0.21).
• These results were consistent across subgroup analyses, including degree of contamination, stoma presence, BMI, and skin preparation.
Researchers concluded that routine use of iNPWT for closed surgical wounds in emergency laparotomies does not reduce SSIs or improve secondary outcomes compared to standard dressings.
Reference:
SUNRRISE Trial Study Group. Negative Pressure Dressings to Prevent Surgical Site Infection After Emergency Laparotomy: The SUNRRISE Randomized Clinical Trial. JAMA. Published online January 27, 2025. doi:10.1001/jama.2024.24764
