Optimizing Closed Incision Negative Pressure Wound Therapy in Emergency Laparotomy (OPTIWOUND): A Multi-arm Randomized Prospective Trial

Abstract

Objective: To evaluate the effectiveness among two incisional negative pressure wound therapy (iNPWT) devices (Prevena™ and PICO™) and compare them with conventional dressings in preventing surgical site occurrences (SSOs), particularly surgical site infections (SSIs), in patients undergoing emergency laparotomies. Summary Background data: Surgical site occurrences (SSOs), particularly infections, are prevalent post-surgery complications, increasing morbidity and healthcare costs. The prophylactic use of advanced wound dressings such as Prevena™ and PICO™ are acclaimed for preventing SSOs. However, there is limited comparative data amongst devices regarding their effectiveness, especially in emergency surgeries which present a high risk for SSOs due to various patient-related factors. Methods: We conducted a randomized controlled trial over a 1-year period. Patients undergoing urgent laparotomy were randomly assigned to Prevena™, PICO™ or conventional dressings. Data on patient demographics, risk factors, and procedural details were collected, with a 30-day post-operative follow-up to monitor primary (SSIs) and secondary outcomes (SSOs, length of stay, complications, reinterventions, readmissions, and mortality). Results: A total of 123 patients were analyzed post-randomization exclusions. The Prevena™ and PICO™ groups demonstrated a significant reduction in SSIs and overall SSOs compared to the conventional dressing group. No significant differences were observed in other postoperative complications, reinterventions, readmissions, or mortality rates across the groups. Conclusion: Prevena™ and PICO™ were more effective than conventional dressings in preventing SSOs and SSIs in emergency laparotomy patients. The study found no statistically significant differences between the two iNPWT devices in terms of overall wound complications, suggesting that device choice can be guided by cost and user experience without compromising clinical outcomes. Further studies are recommended to validate these findings.