In the United States, more than 10,000 radical cystectomies are performed annually, and the majority are done through an open approach [1]. Open radical cystectomy (ORC) is a highly morbid procedure that carries a 60% risk of early postoperative complications, of which, infectious complications have the highest incidence [2]. The increased risk of postoperative infection is multifactorial and comprised of several factors specific to a population of bladder cancer patients, which include advanced age, poor nutritional status, surgical deconditioning, bowel reconstruction, prolonged hospital stays, utilization of neoadjuvant chemotherapy and the proximity of the surgical incision to, in many cases, a reconfigured bowel segment that drains urine colonized by enteric flora. The literature varies in terms of the rate of postoperative infection specific to the surgical site (SSI) in ORC, with an incidence approaching 20% in several series [2,3]. Indeed, we recently noted wound complications in 23% of contemporary patients undergoing ORC at our institution [4]. Therefore, SSI is highly burdensome to both patients and the healthcare system alike.

The prophylactic use of incisional negative pressure wound therapy (iNPWT) devices in surgical patients has been proposed to improve wound related outcomes through removing peri‑incisional interstitial edema, decreasing lateral tension on the incision, increasing microvascular flow, and promoting tissue granulation [[5], [6], [7]]. Prior evidence in several different surgical specialties, including plastic and general surgery, has demonstrated that iNPWT may reduce SSI for procedures such as open abdominal surgery and abdominal wall reconstruction [8]. While there has been 1 study demonstrating the feasibility and benefit of iNPWT for patients undergoing ORC, the overall support for this intervention in abdominopelvic surgery is varied, and its value in urologic surgery remains poorly understood [[5], [6], [7],[9], [10], [11]].

Surgeons at our institution began selectively using prophylactic iNPWT for ORC patients in 2018; however, the association of this practice with wound complications has not been explored or reported. Therefore, we seek to determine the association of iNPWT with wound complications, specifically SSI, following ORC.