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The impact of prophylactic incisional negative pressure wound therapy on surgical site infection following open radical cystectomy
Journal article   Peer reviewed

The impact of prophylactic incisional negative pressure wound therapy on surgical site infection following open radical cystectomy

Daniel S. Roberson, Matthew T McLeay II, Grant Henning, Gianni Morales-Martinez, Prabin Thapa, Abhinav Khanna, Igor Frank, Matthew K. Tollefson, Paras Shah, R. Jeffrey Karnes, …
Urologic oncology, Vol.43(10), pp.586-593
10/2025
DOI: 10.1016/j.urolonc.2025.07.010
PMID: 40796397

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Abstract

•Open radical cystectomy patients are particularly prone to surgical site infection.•Prophylactic incisional negative pressure wound therapy is understudied here.•After adjusting for confounders, wound vac uses decreased risk of wound infection.•This low-risk and low-cost intervention should be considered for such patients. Surgical site infection (SSI) following open radical cystectomy (ORC) is common and carries significant morbidity. Incisional negative pressure wound therapy (iNPWT) has not been rigorously studied in this population. Herein, we evaluate the association between prophylactic iNPWT and postoperative wound complications in ORC patients. We queried our institutional, prospectively maintained cystectomy registry for patients who underwent ORC between 2000 and 2023, and stratified patients by receipt of prophylactic iNPWT. The primary outcome was SSI incidence within 90-days following surgery. Secondary outcomes included 90-day wound dehiscence, symptomatic seroma, and a composite endpoint of any of those 3 wound events. Multivariable logistic regression models adjusted for patient characteristics. Among 2,375 patients who underwent ORC, 124(5.2%) received prophylactic iNPWT. Patients who received iNPWT had higher rates of SSI risk factors: median BMI (31 vs. 28, P < 0.01), diabetes (28% vs. 18%, P = 0.01), and ileal conduit diversion (86% vs. 71%, P < 0.01). On unadjusted analyses, SSI incidence was 6.5% and 10.4% for the iNPWT and non-iNPWT cohorts, respectively. After adjusting for baseline characteristics, prophylactic iNPWT was associated with a significantly lower odds of SSI (OR 0.47, 95%CI 0.22–0.99, P = 0.048). No significant associations were observed between iNPWT utilization and secondary outcomes. Prophylactic iNPWT therapy is associated with a reduced risk of SSI following ORC. While prospective and randomized corroboration is warranted, these data support the incorporation of this low-cost intervention into postoperative pathways for high-risk ORC patients.
 Bladder Cancer Abdominal wound closure Cystectomy Negative pressure wound therapy Surgical wound infection

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