To Örebro University

BACKGROUND: Wound complications after breast surgery are common and contribute to morbidity and healthcare costs. The economic value of prophylactic incisional negative pressure wound therapy (iNPWT) remains uncertain. This study evaluated the effectiveness and cost-effectiveness of iNPWT in preventing postoperative wound complications (freedom from complication), following breast surgery through a systematic review and meta-analysis.

METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched without any restrictions up to 5 March 2025. Randomized trials and prospective or retrospective cohort studies comparing prophylactic iNPWT with standard dressings were included. Two reviewers independently extracted data, assessed risk of bias (RoB 2, ROBINS-I), and graded evidence certainty (GRADE). Random-effects meta-analyses were performed, and cost-effectiveness modelling focused on surgical site infection (SSI).

RESULTS: Twenty-nine studies including 4904 patients (1817 iNPWT; 3087 controls) were analyzed. iNPWT was associated with higher rates of wound dehiscence prevention (RR 1.07, 95% c.i. 1.03-1.12), SSI prevention (RR 1.05, 95% c.i. 1.01-1.09), and skin necrosis prevention (RR 1.07, 95% c.i. 1.01-1.15). No significant differences were observed for seroma, nipple-areolar complex necrosis, or haematoma. Across outcomes, heterogeneity was substantial and 95% prediction intervals crossed the null, indicating uncertainty in the direction of effect in future settings. Evidence certainty ranged from low to moderate. Cost modelling suggested that iNPWT may be cost-saving only in settings with high SSI-related costs.

CONCLUSIONS: Current evidence does not establish consistent clinical benefit of prophylactic iNPWT in breast surgery. Cost-effectiveness appears limited to high-risk or high-cost contexts, supporting selective use.