EP2021 - Closing the Gap: A Systematic Review and Meta-analysis on Improvised Negative Pressure Wound Therapy for the Open Abdomen

Purpose/Background: Open abdomen (OA) management is a lifesaving but complex intervention for severe trauma, abdominal sepsis, and other critical surgical conditions. Negative pressure wound therapy (NPWT) has demonstrated advantages over static temporary abdominal closure (TAC) methods; however, commercial NPWT systems are often inaccessible in low- and middle-income countries (LMICs) due to cost and supply constraints. Improvised NPWT, assembled from readily available surgical materials, is widely used in such settings, yet its clinical performance remains incompletely described.

Methods/Interventions: Thirteen studies (2003-2025) with 19-280 patients each, from diverse global settings, met inclusion criteria. Pooled PFC with improvised NPWT was 66.1% (95% CI 52.9-77.1%), higher in trauma than septic cohorts. EAF incidence was 6.8% (95% CI 2.6-16.7%), and mortality was 26.7% (95% CI 17.4-38.8%). Comparative studies showed similar PFC rates to commercial NPWT (RR 0.72, 95% CI 0.41-1.26) but inconsistent mortality differences (pooled RR 1.40, 95% CI 0.41-4.81). Time to closure, complication rates, and LOS were comparable. Costs were consistently lower with the improvised NPWT. Certainty of evidence was generally low due to study design limitations and heterogeneity.

Results/Outcomes: Thirteen studies (2003-2025) with 19-280 patients each, from diverse global settings, met inclusion criteria. Pooled PFC with improvised NPWT was 66.1% (95% CI 52.9-77.1%), higher in trauma than septic cohorts. EAF incidence was 6.8% (95% CI 2.6-16.7%), and mortality was 26.7% (95% CI 17.4-38.8%). Comparative studies showed similar PFC rates to commercial NPWT (RR 0.72, 95% CI 0.41-1.26) but inconsistent mortality differences (pooled RR 1.40, 95% CI 0.41-4.81). Time to closure, complication rates, and length of stay were largely comparable. Costs were consistently lower with improvised NPWT. Certainty of evidence was generally low due to study design limitations and heterogeneity.

Conclusion/Discussion: Improvised NPWT achieves clinical outcomes broadly comparable to commercial systems in OA management, with substantial cost savings, making it a viable, resource-adaptable option in LMICs. Standardized protocols, high-quality comparative trials, and inclusion in national surgical guidelines are warranted to optimize its use and support policy adoption.

Table 1. Summary of Pooled Outcomes for Improvised NPWT in Open Abdomen