Incisional Negative-Pressure Wound Therapy Versus Standard Dressing for the Prevention of Surgical Site Complications Following Radical Cystectomy

Background/Objectives: Radical cystectomy (RC) is a complex urologic procedure that, when performed using an open surgical approach, carries a high risk of surgical site complications (SSCs), which can lead to prolonged recovery, increased healthcare costs, and higher morbidity. Incisional negative-pressure wound therapy (iNPWT) has demonstrated benefits in enhancing wound healing in various surgical settings, but its effectiveness in the context of RC remains underexplored. This study aimed to evaluate the impact of iNPWT on the incidence of SSCs following RC compared to standard surgical dressings using the PICO® system. Methods: A cohort of 146 patients who underwent RC between 2015 and 2021 was divided into two groups: those treated with standard dressings (Group 1, n = 80) and those who received iNPWT (Group 2, n = 66). Patient-related, surgical, and pathological variables were compared between the groups. Categorical variables were analyzed using the chi-square or Fisher’s exact test, while continuous variables were assessed using Student’s t-test. Univariate logistic regression models were applied to evaluate the association between iNPWT use and 90-day SSCs, as well as to identify risk factors for complications. Results: Group 2 (iNPWT) had a higher prevalence of chronic comorbidities, including chronic kidney disease, but fewer active smokers compared to Group 1. Higher body mass index, prolonged operative time, and uncontrolled diabetes were significantly associated with the development of SSCs. The incidence of SSCs within 90 days was significantly lower in the iNPWT group (7.6%) compared to the standard dressing group (22.5%) (p = 0.03). iNPWT use was associated with a substantially reduced risk of SSCs (OR: 0.282), demonstrating a protective effect. Conclusions: Prophylactic application of iNPWT following RC significantly reduced the incidence of surgical site complications compared to standard dressing. These findings support the potential of iNPWT as a valuable adjunct in perioperative wound management. While encouraging, these results warrant validation in prospective, randomized studies. Tailored postoperative strategies and identification of patient-specific risk factors remain essential components in SSC prevention and reflect the growing importance of precision medicine in surgical oncology.