Negative Pressure Dressings to Prevent Surgical Site Infection After Emergency Laparotomy
Authors: James Brown, Hamish Clouston, Pete Coe, Rui Duarte, Sarah Duff, Rebecca Fish, Paula Ghaneh, James Glasbey, Natalie Ives, Elisabeth Johnston, Manjinder Kaur, Laura Magill, Samir Mehta, Tom Pinkney, Kellie Platt, Peter Pockney, Hema Sekhar, Yash Sinha, Martyn Stott, Richard Wilkin, Hossein Afzali, Kaylani Angerami Almeida, Tom Arthur, Kristy Atherton, Kenneth Chew, Giuliana D'Aulerio, Amanda Dawson, Nagendra Dudi-Venkata, Natasha Egoroff, Tracy Fitzsimmons, Scott Gelzinnis, Maddie Gramlick, Naomi Knoblauch, Natalie Lott, Elizabeth Lun, Vijayaragavan Muralidharan, Kat Penna, Toby Richards, Georgina Riddiough, Suzanne Ryan, Tarik Sammour, Sarah Stanton, Bree Stephensen, Sean Stevens, Vo Uyen, David Watson, Xuanyu Zhou, Neil Corrigan, Matt Costa, Lesley Osborn, Marcos Gomez Ruiz, Joanne Dumville, Nigel Hall, Ly-Mee Yu, Helen Bermingham, Mark Dilworth, Athanasia Filippa, Tabinda Kharodia, Dimitrios Stamatiou, Amy Barnett, Alex Blackmore, Lorraine Hickey, Sarah Melling, Carl Podesta, Karen Hogben, Paula Ng, Abby Oglesby, Edel O'Neill, Yaamini Premakumar, Fahed Youssef, Ahmed Ahmed, Alex Boddy, Emma Bown, Jill Cooke, Tanvir Hossain, David Hunter, Farah Khasawneh, Rosie McDonald, Mohamed Mohamed, Chris Neal, Tom Palser, Tim Rattay, Hisham Zain Butt, Adel Abulkhir, Ziad Al-Khaddar, Khalid Amin, Monica Bogdan, Mumtaz Bughio, Kayode Habeeb, Debra Jowle, Andrew Kennedy-Dalby, Usman Khan, Jennifer Reynolds, Mohammed Sadat, Samer Shami, Chris J Smart, Barbara Townley, Simon Ward, Helen Wassall, Lesley Wilkinson, Verity Haffenden, Christian Macutkiewicz, Katy Newton, April Palacios, Katie Roberts, Alison Blans, Jessica Chang, Kathryn Davies, Alison Hardwick, Martin Nnaji, Julie Roberts, Nuha A Yassin, Karen Convery, Joana Fuentes-Warr, Lisa Hudig, Michael Lewis, Adele Rankin, Steve Brown, Peter Coe, Matthew Lee, Timothy O'Connor, Caroline Steele, Luke Wheldon, Adele Sayers, Deborah Butcher, Robert Dennis, Soumendu Ghosh, Susan O'Sullivan, Muhammed Ali, Alasdair Ball, Elizabeth Buckingham, Sharon Garner, Ewen Griffiths, Kamran Malik, Claire McNeill, Ahmed Nassar, Nicholas Newton, Melissa Oliveira Cunha, Thomas Pinkney, Jonathan Richardson, Samuel Snelling, Benjamin Tan, Stephen Ward, Arlo Whitehouse, Hugo Wolfenden, Deborah Wright, Joanna Curtis, Kirsty Topham, Neil Welch, Maggie Clark, Jennifer Edwards, Susan Moug, Shashi Timalapur, Stephan Duberley, Jillian Fitchett, Nick Heywood, Lyndon Jones, Julie Chadwick, Christine Dawe, Gemma Faulkner, Christa Hammill, Robert Hull, Marta Martinez-Iglesias, Shenbaga Rajamanickam, Natalie Silva, Jack Turnbull, Anne Keen, Karen Knowles, Clare Mason, Lesley McAlpine, Lyndsay Pearce, Adam Rees, Dominic Slade, Vicky Thomas, Mohamed Albendary, Julie Colley, Sibet Joseph, Jenny Porter, Stephen Stonelake, Andrew Torrance, Shafquat Zaman, Claire Hall, Nachiket Joshi, Janet Marrs, Callula Nulty, Adeel Bajwa, Chelsea Stokes, Greg Williams, Annalie Baker, Bridget Campbell, William Ho, Muhammad Imran Aslam, Charalampos Konstantinou, Paul Marriott, Laura Balance, Alphonsa Biju, Ayla Brown, Benjamin Brown, Caroline Byrne, Taher Fatayer, Rachel Hine, Tasadooq Hussain, Raef Jackson, Mohammed Mamunur Rahman, Richard McCormick, George McNally, Preethy Ninan, Tracy Noone, Meera Patel, Jennifer Redfern, Jyotimoy Roy, Sarah Staight, Sharon Storey, Rebecca Varley, Danile Cox, Cassidy Campbell, Ramiz Iqbal, Sean Park, Henry Cheung, Dulani Goonawardhana, Roy Huynh, Zhang Xinyi, Amelia Davis, Danika Jurat, Pamphila Lovelle Loh, Hayley McMillan, Anand Trivedi, Uyen Vo, Mohammed A Afzal, Savio G Barreto, Rebecca Fong, James Grantham, Benjamin Gricks, Amanda Hii, Nikhil Kundu, Yick Ho Lam, David Liu, Charles Livingston, Gavin Nair, Beeshan Ong, Olivia Pickering, Like Traeger, Ravi Vissapragada, Melissa Wee, Jordan Lavigne, Philip Townend, Sara Clark, Andrew Drana, Eu Jhin Loh, Winy Widjaja, Alam Ahmad, Tien Yew Chern, Adam Christie, Suzanne Di Sano, Mostafa Elkawaga, Mark Fenton, Madelyn Gramlick, Benjamin Griffiths, Saksham Gupta, Merran Holmes, Daniel McIlroy, Luke Peters, Josefine Petersson, Stephen Smith, Elvina Wiadji, Jie Zhao, Gayatri Asokan, Antonio Barbaro, James Besanko, Amandeep Chugha, Nagendra Dudi-Vankata, Jaime Duffield, Timothy Ganguly, Izhar-Ul Haque, Matheesha Herath, Hidde Kroon, Alicia Lam, Victoria Lun, Alain Nguyen, Daniel Ong, Steven Tran, Luci Van de Ven, Ryash Vather, Jake Willet, Geoffrey Wong, Leigh Archer, Tina Dilevska, Jonathan Foo, David Hudson, Sasha Martin, Ynui Ongso, Yeow Chun Tee, Matthew Trinder, Nicole Walsh, Bichen Zhao, Keith Garaghty, Benjamin Harrison, Patrick Tan, Paige Barnard, Kit-Suen Choi, Lucy Hempenstall, Brittany Long, Nikhil Narsey, Gabriella Savage, Hannah Tang, Kate Brailsford, Erum Khan, Gurmail Rai, Natalie Rowland, Kristy Atherton, James Brown, Hamish Clouston, Pete Coe, Rui Duarte, Nagendra N. Dudi-Venkata, Sarah Duff, Natasha Egoroff, Rebecca Fish, James Glasbey, Natalie Ives, Manjinder Kaur, Laura Magill, Samir Mehta, Thomas Pinkney, Peter Pockney, Toby Richards, Tarik Sammour, Hema Sekhar, Yash Sinha, Martyn Stott, Richard Wilkin
Journal: JAMA (2025)

Importance Patients undergoing unplanned abdominal surgical procedures are at increased risk of surgical site infection (SSI). It is not known if incisional negative pressure wound therapy (iNPWT) can reduce SSI rates in this setting. Objective To evaluate the effectiveness of iNPWT in reducing the rate of SSI in adults undergoing emergency laparotomy with primary skin closure. Design, Setting, and Participants SUNRRISE was an assessor-masked, pragmatic, phase 3, individual-participant, randomized clinical trial. Adult patients undergoing emergency laparotomy in 22 hospitals in the UK and 12 hospitals in Australia between December 18, 2018, and May 25, 2021, were recruited. Patients were followed up for 30 days postprocedure; database closure was on August 25, 2021. Interventions Participants were randomized 1:1 to receive iNPWT (n = 411), which involved a specialized dressing used to create negative pressure over the closed wound vs the surgeon’s choice of wound dressing (n = 410). Randomization and dressing application occurred in the operating room at the end of the surgical procedure. Main Outcomes and Measures The primary outcome measure was SSI up to 30 days postprocedure, evaluated by an assessor masked to the randomized allocation and using criteria from the US Centers for Disease Control and Prevention. There were 7 secondary outcomes, including length of hospital stay, postoperative complications up to 30 days, hospital readmission for wound-related complications within 30 days, wound pain, and quality of life. Results A total of 840 patients were randomized (536 from the UK; 304 from Australia). Overall, 52% were female; the mean age was 63.8 (range, 18.8 to 95.3) years. After postrandomization exclusions (N = 52), 394 participants per group were included in the primary analysis. The number of participants who had an SSI in the iNPWT group was 112 of 394 (28.4%), compared with 108 of 394 (27.4%) in the surgeon’s preference group (relative risk, 1.03 [95% CI, 0.83-1.28]; P = .78). This finding was consistent across the preplanned subgroup analyses, including degree of contamination, presence of a stoma, participant body mass index, and skin preparation used, and across all preplanned sensitivity analyses. Of 7 secondary outcomes, 6 showed no significant difference, including hospital readmission, quality of life, and hospital stay (median [IQR], 8 [6-14] days in the iNPWT group and 9 [6-14.5] days in the surgeon’s preference group [ratio of geometric means, 0.96 (95% CI, 0.88-1.06); P = .21]). Conclusions and Relevance Routine application of iNPWT to the closed surgical wound after emergency laparotomy did not prevent SSI more than other dressings. Trial Registration isrctn.com Identifier: ISRCTN17599457 ; anzctr.org.au Identifier: ACTRN12619000496112