Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis
Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and the...
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| Veröffentlicht in: | Archives of surgery (Chicago. 1960) 2024-07, Vol.159 (7), p.792 |
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| creator | Groenen, Hannah Bontekoning, Nathan Jalalzadeh, Hasti Buis, Dennis R Dreissen, Yasmine E M Goosen, Jon H M Graveland, Haitske Griekspoor, Mitchel IJpma, Frank F A van der Laan, Maarten J Schaad, Roald R Segers, Patrique van der Zwet, Wil C Orsini, Ricardo G Eskes, Anne M Wolfhagen, Niels de Jonge, Stijn W Boermeester, Marja A |
| description | Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.
To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.
PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.
Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.
This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.
The primary study outcome was SSI.
A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).
This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns. |
| doi_str_mv | 10.1001/jamasurg.2024.0775 |
| format | Article |
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To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.
PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.
Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.
This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.
The primary study outcome was SSI.
A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).
This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.</description><identifier>ISSN: 2168-6254</identifier><identifier>ISSN: 2168-6262</identifier><identifier>EISSN: 2168-6262</identifier><identifier>DOI: 10.1001/jamasurg.2024.0775</identifier><identifier>PMID: 38656408</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Anti-Infective Agents, Local - administration & dosage ; Anti-Infective Agents, Local - therapeutic use ; Clinical trials ; Drug resistance ; Humans ; Network Meta-Analysis ; Randomized Controlled Trials as Topic ; Surgical site infections ; Surgical Wound Infection - prevention & control ; Therapeutic Irrigation - methods</subject><ispartof>Archives of surgery (Chicago. 1960), 2024-07, Vol.159 (7), p.792</ispartof><rights>Copyright American Medical Association Jul 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c197t-c3d1a89c8a7b4a05b1ca280b07bb56ffba0829e7f6f8083bdde5cb3c7c0558123</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38656408$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Groenen, Hannah</creatorcontrib><creatorcontrib>Bontekoning, Nathan</creatorcontrib><creatorcontrib>Jalalzadeh, Hasti</creatorcontrib><creatorcontrib>Buis, Dennis R</creatorcontrib><creatorcontrib>Dreissen, Yasmine E M</creatorcontrib><creatorcontrib>Goosen, Jon H M</creatorcontrib><creatorcontrib>Graveland, Haitske</creatorcontrib><creatorcontrib>Griekspoor, Mitchel</creatorcontrib><creatorcontrib>IJpma, Frank F A</creatorcontrib><creatorcontrib>van der Laan, Maarten J</creatorcontrib><creatorcontrib>Schaad, Roald R</creatorcontrib><creatorcontrib>Segers, Patrique</creatorcontrib><creatorcontrib>van der Zwet, Wil C</creatorcontrib><creatorcontrib>Orsini, Ricardo G</creatorcontrib><creatorcontrib>Eskes, Anne M</creatorcontrib><creatorcontrib>Wolfhagen, Niels</creatorcontrib><creatorcontrib>de Jonge, Stijn W</creatorcontrib><creatorcontrib>Boermeester, Marja A</creatorcontrib><title>Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis</title><title>Archives of surgery (Chicago. 1960)</title><addtitle>JAMA Surg</addtitle><description>Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.
To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.
PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.
Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.
This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.
The primary study outcome was SSI.
A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).
This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.</description><subject>Anti-Infective Agents, Local - administration & dosage</subject><subject>Anti-Infective Agents, Local - therapeutic use</subject><subject>Clinical trials</subject><subject>Drug resistance</subject><subject>Humans</subject><subject>Network Meta-Analysis</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Surgical site infections</subject><subject>Surgical Wound Infection - prevention & control</subject><subject>Therapeutic Irrigation - methods</subject><issn>2168-6254</issn><issn>2168-6262</issn><issn>2168-6262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU9P3DAQxS1EBYjuF-ihstRLL1nGTpw4va1QoSvxT90ijpHtjKm3m5jaCXS_PU5hOeDLWDO_92akR8gnBnMGwE7WqlNxDPdzDryYQ1WJPXLEWSmzkpd8_-0vikMyi3EN6UmAIq8PyGEuS1EWII_Iv2VvXHS-Vxt658e-pcsQ3L0aUotaH-jwG-lNwEfs_7e8pau01ZnEr9yAdNlbNNPoG13Q1TYO2CWxoT_x0eETVcnxCocnH_7QSxxUtkibttHFj-SDVZuIs9d6TG7Pvv86_ZFdXJ8vTxcXmWF1NWQmb5mStZGq0oUCoZlRXIKGSmtRWqsVSF5jZUsrQea6bVEYnZvKgBCS8fyYfH3xfQj-74hxaDoXDW42qkc_xiaHohSMA6sT-uUduvZjSPdOVM1lzQshE8VfKBN8jAFt8xBcp8K2YdBM0TS7aJopmmaKJok-v1qPusP2TbILIn8GSRCMzw</recordid><startdate>20240701</startdate><enddate>20240701</enddate><creator>Groenen, Hannah</creator><creator>Bontekoning, Nathan</creator><creator>Jalalzadeh, Hasti</creator><creator>Buis, Dennis R</creator><creator>Dreissen, Yasmine E M</creator><creator>Goosen, Jon H M</creator><creator>Graveland, Haitske</creator><creator>Griekspoor, Mitchel</creator><creator>IJpma, Frank F A</creator><creator>van der Laan, Maarten J</creator><creator>Schaad, Roald R</creator><creator>Segers, Patrique</creator><creator>van der Zwet, Wil C</creator><creator>Orsini, Ricardo G</creator><creator>Eskes, Anne M</creator><creator>Wolfhagen, Niels</creator><creator>de Jonge, Stijn W</creator><creator>Boermeester, Marja A</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20240701</creationdate><title>Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis</title><author>Groenen, Hannah ; 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Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.
To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.
PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.
Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.
This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.
The primary study outcome was SSI.
A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).
This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>38656408</pmid><doi>10.1001/jamasurg.2024.0775</doi></addata></record> |
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| ispartof | Archives of surgery (Chicago. 1960), 2024-07, Vol.159 (7), p.792 |
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| source | MEDLINE; American Medical Association Journals |
| subjects | Anti-Infective Agents, Local - administration & dosage Anti-Infective Agents, Local - therapeutic use Clinical trials Drug resistance Humans Network Meta-Analysis Randomized Controlled Trials as Topic Surgical site infections Surgical Wound Infection - prevention & control Therapeutic Irrigation - methods |
| title | Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis |
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