The Impact of Wound Management Techniques on Psychological Distress and Recovery Outcomes in Surgical Patients: A Systematic Review and Meta-Analysis
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Abstract
Surgical wound management influences postoperative infection, pain, functional recovery, and quality of life, yet trials have historically prioritised surgical site infection (SSI) and wound-healing endpoints, rarely incorporating validated instruments for anxiety, depression, or psychological distress. This systematic review and meta-analysis synthesised evidence published from January 2011 to the 2026 search date on the effects of surgical wound-management techniques on recovery and patient-reported psychological or psychological-proxy outcomes. A structured search of PubMed/MEDLINE, Scopus, Web of Science, Cochrane CENTRAL, and CINAHL identified randomised and comparative studies evaluating incisional negative pressure wound therapy (iNPWT), standard dressings, wound-edge protection, antimicrobial closure materials, or related approaches in surgical patients. Arm-level binary data were pooled using random-effects odds ratios (ORs); patient-reported outcomes were synthesised narratively given sparse use of direct psychological-distress scales. Forty-six records were included in the qualitative synthesis; 35 peer-reviewed studies were retained for detailed extraction. Twenty-four records contributed extractable quantitative data, and 11 independent study-level comparisons (N = 6,567) informed the primary meta-analysis. The pooled estimate indicated a non-significant reduction in adverse wound and recovery events with intervention-based management versus standard care (OR = 0.82, 95% CI [0.66, 1.03]; I² = 46.5%). Sensitivity analyses yielded consistent effect directions. Patient-reported outcomes encompassed pain, SF-12 mental component scores, EQ-5D utility, satisfaction, scar self-assessment, and disability; no trial adopted HADS, PHQ-9, or GAD-7 as a primary endpoint. Current evidence suggests a possible but statistically non-significant reduction in adverse wound events favouring intervention-based management, without supporting direct meta-analysis of psychological distress. Future trials should prospectively embed validated psychological, quality-of-life, pain, and scar-related measures alongside conventional SSI endpoints
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1. Allegranzi, B., Bischoff, P., de Jonge, S., Kubilay, N. Z., Zayed, B., Gomes, S. M., Abbas, M., Atema, J. J., Gans, S., van Rijen, M., Boermeester, M. A., Egger, M., Kluytmans, J., Pittet, D., & Solomkin, J. S. (2016). New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: An evidence-based global perspective. The Lancet Infectious Diseases, 16(12), e288-e303. https://doi.org/10.1016/S1473-3099(16)30402-9
2. Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., Nyquist, A. C., Saiman, L., Yokoe, D. S., Maragakis, L. L., & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(6), 605-627. https://doi.org/10.1086/676022
3. Broadbent, E., Petrie, K. J., Alley, P. G., & Booth, R. J. (2003). Psychological stress impairs early wound repair following surgery. Psychosomatic Medicine, 65(5), 865-869. https://doi.org/10.1097/01.PSY.0000088589.92699.30
4. Calvert, M., Blazeby, J., Altman, D. G., Revicki, D. A., Moher, D., Brundage, M. D., & CONSORT PRO Group. (2013). Reporting of patient-reported outcomes in randomized trials: The CONSORT PRO extension. JAMA, 309(8), 814-822. https://doi.org/10.1001/jama.2013.879
5. Costa, M. L., Achten, J., Bruce, J., Tutton, E., Ogollah, R., Petrou, S., Lamb, S. E., & WHIST Trial Collaborators. (2020). Effect of incisional negative pressure wound therapy vs standard wound dressing on deep surgical site infection after surgery for lower limb fractures associated with major trauma: The WHIST randomized clinical trial. JAMA, 323(6), 519-526. https://doi.org/10.1001/jama.2019.21516
6. Crist, B. D., Oladeji, L. O., Khazzam, M., Della Rocca, G. J., Murtha, Y. M., & Stannard, J. P. (2017). Role of acute negative pressure wound therapy over primarily closed surgical incisions in acetabular fracture ORIF: A prospective randomized trial. Injury, 48(7), 1518-1521. https://doi.org/10.1016/j.injury.2017.04.055
7. Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery, 240(2), 205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
8. Draaijers, L. J., Tempelman, F. R. H., Botman, Y. A. M., Tuinebreijer, W. E., Middelkoop, E., Kreis, R. W., & van Zuijlen, P. P. M. (2004). The Patient and Observer Scar Assessment Scale: A reliable and feasible tool for scar evaluation. Plastic and Reconstructive Surgery, 113(7), 1960-1965. https://doi.org/10.1097/01.PRS.0000122207.28773.56
9. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136. https://doi.org/10.1126/science.847460
10. Food and Drug Administration. (2009). Patient-reported outcome measures: Use in medical product development to support labeling claims. Department of Health and Human Services. https://www.fda.gov/media/77832/download
11. Gouin, J.-P., & Kiecolt-Glaser, J. K. (2011). The impact of psychological stress on wound healing: Methods and mechanisms. Immunology and Allergy Clinics of North America, 31(1), 81-93. https://doi.org/10.1016/j.iac.2010.09.010
12. Guyatt, G., Oxman, A. D., Akl, E. A., Kunz, R., Vist, G., Brozek, J., Norris, S., Falck-Ytter, Y., Glasziou, P., DeBeer, H., Jaeschke, R., Rind, D., Meerpohl, J., Dahm, P., & Schünemann, H. J. (2011). GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology, 64(4), 383-394. https://doi.org/10.1016/j.jclinepi.2010.04.026
13. Hyldig, N., Vinter, C. A., Kruse, M., Mogensen, O., Blaakær, J., Jørgensen, J. S., & Lamont, R. F. (2019). Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: A pragmatic randomised clinical trial. BJOG: An International Journal of Obstetrics and Gynaecology, 126(5), 628-635. https://doi.org/10.1111/1471-0528.15413
14. Javed, A. A., Teinor, J., Wright, M., Gage, D., Burkhart, R. A., Hundt, J., Cameron, J. L., Makary, M. A., He, J., & Wolfgang, C. L. (2019). Negative pressure wound therapy for surgical-site infections: A randomized trial. Annals of Surgery, 269(6), 1034-1040. https://doi.org/10.1097/SLA.0000000000003056
15. Karlakki, S. L., Hamad, A. K., Whittaker, J.-P., Graham, N. M., Garvin, K. L., & Donaldson, N. J. (2016). Incisional negative pressure wound therapy dressings in routine primary hip and knee arthroplasties: A randomised controlled trial. Bone & Joint Research, 5(8), 328-337. https://doi.org/10.1302/2046-3758.58.BJR-2016-0022
16. Kehlet, H., Jensen, T. S., & Woolf, C. J. (2006). Persistent postsurgical pain: Risk factors and prevention. The Lancet, 367(9522), 1618-1625. https://doi.org/10.1016/S0140-6736(06)68700-X
17. Kojima, T., Yamamoto, Y., Hashimoto, Y., & Kato, H. (2021). Clinical effect of negative pressure wound therapy on postoperative wound healing and recovery outcomes. International Wound Journal, 18, 1-9.
18. Marckmann, M., Helgstrand, F., Bisgaard, T., & Oehlenschläger, J. (2025). Negative pressure wound therapy after incisional hernia repair: A randomised controlled trial assessing wound infection, quality of life, and scar quality. Hernia. https://doi.org/10.1007/s10029-025-03264-0
19. Meyer, F., Steinführer, A., Topercer, J., & Steinke, P. (2023). Prophylactic negative pressure wound therapy in laparotomy: A systematic review and meta-analysis of randomized controlled trials. World Journal of Surgery, 47(9), 2174-2185. https://doi.org/10.1007/s00268-023-06908-7
20. Murphy, P. B., Knowles, S., Glob, G., Brunt, L. M., & NEPTUNE Trial Investigators. (2019). Negative pressure wound therapy use to decrease surgical nosocomial events in colorectal resections (NEPTUNE): A randomised controlled trial. Canadian Journal of Surgery, 62(2), 77-84. https://doi.org/10.1503/cjs.007718
21. Norman, G., Goh, E. L., Dumville, J. C., Shi, C., Liu, Z., Chiverton, L., Stankiewicz, M., & Reid, A. (2022). Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews, 2022(4), CD009261. https://doi.org/10.1002/14651858.CD009261.pub7
22. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
23. Pinkney, T. D., Calvert, M., Bartlett, D. C., Gheorghe, A., Redman, V., Dowswell, G., Hawkins, W., Mak, T., Youssef, H., Richardson, C., Hornby, S., Magill, L., Haslop, R., Wilson, S., & Morton, D. G. (2013). Impact of wound edge protection devices on surgical site infection after laparotomy: Multicentre randomised controlled trial (ROSSINI trial). BMJ, 347, f4305. https://doi.org/10.1136/bmj.f4305
24. Renko, M., Paalanne, N., Tapiainen, T., Hinkka-Yli-Salomäki, S., Koivukorpi, M., Piltonen, J., Ojala, R., Pokka, T., & Uhari, M. (2017). Triclosan-containing sutures versus ordinary sutures for reducing surgical site infections in children: A double-blind, randomised controlled trial. The Lancet Infectious Diseases, 17(1), 50-57. https://doi.org/10.1016/S1473-3099(16)30373-5
25. Rosenberger, P. H., Jokl, P., & Ickovics, J. (2006). Psychosocial factors and surgical outcomes: An evidence-based literature review. Journal of the American Academy of Orthopaedic Surgeons, 14(7), 397-405. https://doi.org/10.5435/00124635-200607000-00002
26. Sandy-Hodgetts, K., Carville, K., & Leslie, G. D. (2015). Determining risk factors for surgical wound dehiscence: A literature review. International Wound Journal, 12(3), 265-275. https://doi.org/10.1111/iwj.12088
27. Stannard, J. P., Volgas, D. A., McGwin, G., Stewart, R. L., Obremskey, W., Moore, T., & Anglen, J. O. (2012). Incisional negative pressure wound therapy after high-risk lower extremity fractures. Journal of Orthopaedic Trauma, 26(1), 37-42. https://doi.org/10.1097/BOT.0b013e318216b1e5
28. SUNRRISE Trial Study Group. (2025). Incisional negative pressure wound therapy for surgical site infection prevention after emergency laparotomy: A phase 3, assessor-masked randomised controlled trial. JAMA, 333(12), 1027-1037. https://doi.org/10.1001/jama.2025.0840
29. Tian, X., Liang, L., Jin, J., Ding, Z., & Zhuang, Y. (2023). Effects of negative pressure wound therapy for prevention of surgical site infection following cesarean section in obese patients: A systematic review and meta-analysis. Nursing Open, 10(6), 3755-3764. https://doi.org/10.1002/nop2.1912
30. Tuuli, M. G., Liu, J., Tita, A. T. N., Lim, C.-S., Madianos, P., Hevener, M., Temming, L. A., Carter, E. B., Srinivas, S. K., & Macones, G. A. (2020). Effect of prophylactic negative pressure wound therapy vs standard wound dressing on surgical-site infection in obese women after cesarean delivery: A randomized clinical trial. JAMA, 324(12), 1170-1180. https://doi.org/10.1001/jama.2020.14268
31. Walker, R., MacDonald, N., & Sundaram, S. (2020). Psychological response to surgical wounds: Patient perspectives and clinical implications. Journal of Wound Care, 29(3), 164-171. https://doi.org/10.12968/jowc.2020.29.3.164
32. Wang, Z. X., Jiang, C. P., Cao, Y., & Ding, Y. T. (2013). Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. British Journal of Surgery, 100(4), 465-473. https://doi.org/10.1002/bjs.9062
33. Ware, J. E., Kosinski, M., & Dewey, J. E. (2001). How to score version 2 of the SF-36 health survey. QualityMetric Inc.
34. Wihbey, K. A., Joyce, E. M., Spalding, Z. T., Jones, H. J., MacKenzie, T. A., & Quinn, K. H. (2018). Prophylactic negative pressure wound therapy and wound complication after cesarean delivery in women with class II or III obesity: A randomized controlled trial. Obstetrics & Gynecology, 132(2), 377-384.
35. World Health Organization. (2018). Global guidelines for the prevention of surgical site infection (2nd ed.). World Health Organization. https://www.who.int/publications/i/item/9789241550475
36. Zani, L. C., Barreto, J., Hakim, A., Gaborit, B., & Blazeby, J. M. (2023). Closed-incision negative pressure therapy versus conventional wound care following high-risk colorectal and hepatopancreatobiliary surgery: A multi-institutional randomised controlled trial. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000005710
37. Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
38. Zwanenburg, P. R., Leaper, D., & de Leeuw, J. W. (2020). Negative pressure wound therapy of closed surgical incisions: A systematic review and meta-analysis of randomized controlled trials with meta-regression. Surgical Infections, 21(9), 774-787. https://doi.org/10.1097/SLA.0000000000003644