Role of Prophylactic Negative Pressure Wound Therapy in Reducing Surgical-Site Infections in Spine Surgery – A Systematic Review and Meta-Analysis

Study Design Systematic Review and Meta-analysis. Objective To evaluate the prophylactic efficacy of incisional negative pressure wound therapy(NPWT) in mitigating the postoperative complications following primary spine surgery. Methods A comprehensive search of the databases (PubMed, Embase, Scopus and Web of Science) was performed until October 2025 since inception. Studies comparing incisional NPWT vs standard wound dressing after primary spine surgery were included if at least one of the relevant outcome measures was reported. While the primary endpoint was surgical site infection(SSI), the evaluated secondary outcomes included wound complications, reoperations, readmissions, length of hospital stay(LOS), and cost-effectiveness. Random-effects meta-analysis with Knapp-Hartung adjustment was employed to calculate pooled odds ratios(ORs) and mean differences(MD). The risk of bias assessment was made using the Cochrane ROB2 tool and Newcastle Ottawa Scale. Results Thirteen studies comprising 7619 patients(851NPWT and 6,768controls) were analysed. NPWT significantly mitigated the SSI rates[OR = 0.42, 95%CI(0.28-0.63) P < 0.001; I 2 = 78%) and wound complications[OR = 0.51,95%CI(0.33-0.78) P = 0.03; P = 0.03; I 2 = 0%]. In contrast, reoperation rates[OR = 0.68,95%CI(0.39-1.18)], readmissions[OR = 0.76,95%CI(0.45-1.29)], and LOS [MD = −1.05days,95%CI(−2.16,0.07)] demonstrated non-significant trends, indicating the clinical implications of these secondary outcomes remain uncertain. Two studies reported marked cost savings, with up to $12.9 saved for per $1 spent on NPWT. No significant publication bias was observed. Conclusion Prophylactic incisional NPWT is associated with reduced SSI and wound complications in spine surgery. Given the predominance of retrospective studies, protocol heterogeneity, and limited cost-effectiveness data, these findings should be interpreted cautiously. Current evidence suggests NPWT may be most beneficial in selected high-risk patients, with larger multicentric RCTs needed to confirm routine use and economic value.