Negative pressure incisional wound therapy for high-risk ventral hernia repair: a randomized controlled trial and meta-analysis

BACKGROUND: Despite advances in prosthetic material and surgical technique, wound-related complications after ventral hernia repairs remain common and a primary determinant of postoperative morbidity. We sought to evaluate negative pressure wound therapy (NPWT), a low-cost intervention to improve wound outcomes that has been proven in other surgical contexts. METHODS: We report a multicentre randomized controlled trial (RCT) evaluating NPWT versus sterile dressing in adult patients undergoing surgical repair of ventral hernias with 1 or more risk factors for postoperative surgical site complications. Our primary outcome was the composite of any surgical site complication. Secondary outcomes were cost-effectiveness and quality of life, evaluated using the Hernia-Related Quality-of-Life Survey (HerQLes). We conducted a meta-analysis of this study and 2 other RCTs. RESULTS: Of 110 patients who met inclusion criteria, 107 had primary outcome data at a median follow-up of 33 days. The primary outcome occurred in 15 (27.8%) of 54 patients in the NPWT group and 25 (47.2%) of 53 patients in the control group, for a relative risk of 0.59 (95% confidence interval [CI] 0.35 to 0.99). Meta-analysis found a pooled relative risk of 0.56 (95% CI 0.39 to 0.81). Postoperative quality of life was significantly higher in the NPWT group (HerQLes score 88.3 [95% CI 75.8 to 94.2] v. 73.3 [95% CI 52.5 to 93.3]). Cost-effectiveness of the NPWT was US$160 per quality-adjusted life year. CONCLUSION: Prophylactic NPWT in high-risk ventral hernia repair reduces the incidence of surgical site complications, is associated with a higher postoperative quality of life, and is highly cost-effective.