Incisional Negative Pressure Wound Therapy: The clinical effect on post-caesarean wound complications in obese women

Women with a pre-gestational body mass index (BMI) above 30 kg/m2 giving birth by caesarean section are at high risk of surgical wound infection compared with women with a BMI below 30 kg/m2. Incisional Negative Pressure Wound Therapy (iNPWT) is one strategy to reduce the rate of surgical wound infection. However, the treatment is relatively costly compared to standard postoperative dressings and thus it was important to consider the rationale for using iNPWT before introducing the treatment in a clinical setting.
This thesis assesses the current evidence of whether iNPWT reduces post-surgical wound complications when applied to closed surgical incisions. The meta-analysis showed that iNPWT appears to reduce the risk of post-surgical wound infection and seroma formation in high-risk wounds compared with standard postoperative dressings in selected surgical procedures.
The thesis comprises a randomised controlled trial in two tertiary and three teaching hospitals in three regions of Denmark, the Happy Belly Study, investigating the effectiveness of iNPWT in a population of obese women after caesarean section. The Happy Belly Study has demonstrated that prophylactic iNPWT significantly reduced the rate of surgical wound infection and wound exudate post-caesarean and that wound infection had a negative impact on quality of life one month after surgery.
Alongside the clinical trial, a trial-based cost-effectiveness analysis demonstrated that the treatment is cost-effective in a high-risk population of obese women giving birth by caesarean section.
The Happy Belly Study is ongoing and thus this thesis presents preliminary results based on data from the first two-thirds of the scheduled study participants. Nonetheless, the results in this thesis are convincing. Accordingly, iNPWT is a potential simple non-invasive strategy for prevention of post-surgical wound complications that does not cause considerable inconvenience to the patient or require additional resources to be implemented in clinical practice. If the final results demonstrate the same significant impact as these preliminary results, they will lead to the recommendation of prophylactic iNPWT as a standard clinical procedure for women at high risk of wound complications after caesarean section.