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The effect of intraoperative wound protector use on the risk of surgical site infections in patients undergoing pancreatoduodenectomy: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
  • Published:
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Abstract

Aims

To evaluate the effect of intraoperative wound protectors on the risk of surgical site infection (SSI) in patients undergoing pancreatoduodenectomy.

Methods

In compliance with PRISMA statement standards, electronic databases were searched to identify all studies comparing wound protector use with no wound protector use in patients undergoing pancreatoduodenectomy. SSI (superficial or deep) was considered primary outcome measure. The secondary outcome measures included superficial SSI, deep SSI, and organ-space SSI. Random effects modelling was applied to calculate pooled outcome data. The certainty of evidence was assessed using GRADE system.

Results

A total of 12159 patients from four studies were included. The included populations in both groups were comparable in terms of baseline characteristics. The use of wound protector was associated with lower risk of superficial or deep SSI (OR: 0.55, 95% CI 0.43–0.70, P<0.00001), superficial SSI (OR: 0.59, 95% CI 0.46–0.76, P<0.0001), and organ-space SSI (OR: 0.80, 95% CI 0.72–0.90, P=0.0002). There was no difference between the two groups in terms of the risk of deep SSI (OR: 0.68, 95% CI 0.43–1.06, P=0.09) although this may be subject to type 2 error.

Conclusions

The results of current study suggests that the use of intraoperative wound protector during pancreatoduodenectomy may reduce the risk of postoperative SSI. The quality of the available evidence is moderate with high certainty. While evidence from future randomised controlled trials could increase the robustness of our conclusions, we do not hesitate to recommend the use of wound protectors during pancreatoduodenectomy based on the current evidence.

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References

  1. Bilgiç Ç, Keske Ş, Sobutay E, Can U, Zenger S, Gürbüz B, Ergönül Ö, Bilge O (2020) Surgical site infections after pancreaticoduodenectomy: preoperative biliary system interventions and antimicrobial prophylaxis. Int J Infect Dis. 95:148–152 (Jun)

    Article  Google Scholar 

  2. Kirkland KB, Briggs JP, Trivette SL,WilkinsonWE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20: 725–730.

  3. Fadayomi AB, Kasumova GG, Tabatabaie O, de Geus SWL, Kent TS, Ng SC et al (2018 Jul) Unique predictors and economic burden of superficial and deep/organ space surgical site infections following pancreatectomy. HPB (Oxford). 20(7):658–668

    Article  Google Scholar 

  4. Ceppa EP, Pitt HA, House MG, Kilbane EM, Nakeeb A, Schmidt CM et al (2013 May) Reducing surgical site infections in hepatopancreatobiliary surgery. HPB (Oxford). 15(5):384–391

    Article  Google Scholar 

  5. Zimlichman E, Henderson D, Tamir O et al (2013) Health careassociated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 173:2039e2046

    Article  Google Scholar 

  6. Edwards JP, Ho AL, Tee MC, Dixon E, Ball CG (2012 Jul) Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials. Ann Surg. 256(1):53–59

    Article  Google Scholar 

  7. Mihaljevic AL, Müller TC, Kehl V, Friess H, Kleeff J (2015) Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis. PLoS One. 10(3):e0121187

    Article  Google Scholar 

  8. Zhang L, Elsolh B, Patel SV (2018 Mar) Wound protectors in reducing surgical site infections in lower gastrointestinal surgery: an updated meta-analysis. Surg Endosc. 32(3):1111–1122

    Article  Google Scholar 

  9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP et al (2009 Jul) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 21(339):b2700

    Article  Google Scholar 

  10. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) (2019) Cochrane Handbook for Systematic Reviews of Interventions, 2nd edn. John Wiley & Sons, Chichester (UK)

    Google Scholar 

  11. Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. Available at GRADE handbook (gradepro.org) (last accessed 28 November 2020).

  12. Centers for Disease Control and Prevention: CDC/NHSN Protocol corrections, clarification, and additions; April 2013. Available at: http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed January 2013.

  13. Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane, 2020. Available from www.training.cochrane.org/handbook. (last accessed 28 November 2020).

  14. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M et al (2016 Oct) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 12(355):i4919

    Article  Google Scholar 

  15. Tee MC, Chen L, Franko J, Edwards JP, Raman S, Ball CG. Effect of wound protectors on surgical site infection in patients undergoing whipple procedure. HPB (Oxford). 2020 Dec 15:S1365-182X(20)32391-1.

  16. De Pastena M, Marchegiani G, Paiella S, Fontana M, Esposito A, Casetti L et al (2020) Use of an intraoperative wound protector to prevent surgical-site infection after pancreatoduodenectomy: randomized clinical trial. Br J Surg. 107(9):1107–1113

    Article  Google Scholar 

  17. Lawrence SA, McIntyre CA, Pulvirenti A, Seier K, Chou Y, Gonen M et al (2019) Perioperative bundle to reduce surgical site infection after pancreaticoduodenectomy: a prospective cohort study. J Am Coll Surg. 228(4):595–601

    Article  Google Scholar 

  18. Bressan AK, Aubin JM, Martel G, Dixon E, Bathe OF, Sutherland FR et al (2018) Efficacy of a dual-ring wound protector for prevention of surgical site infections after pancreaticoduodenectomy in patients with intrabiliary stents: a randomized clinical trial. Ann Surg. 268(1):35–40 (Jul)

    Article  Google Scholar 

  19. Ahmed K, Connelly TM, Bashar K, Walsh SR (2016 Feb) Are wound ring protectors effective in reducing surgical site infection post appendectomy? A systematic review and meta-analysis. Ir J Med Sci. 185(1):35–42

    Article  CAS  Google Scholar 

  20. Liu JB, Baker MS, Thompson VM, Kilbane EM, Pitt HA (2019) Wound protectors mitigate superficial surgical site infections after pancreatoduodenectomy. HPB (Oxford). 21(1):121–131

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of General Surgery, Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham, UK

    Karim Hassan, Sumera Baloch, Elsie Jia Zhi Tan, James Chamberlain & Ahsan Ashfaq

  2. Department of General Surgery, North Manchester Care Organisation, North Manchester General Hospital, Manchester, UK

    Jigar Shah

  3. Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK

    Shahin Hajibandeh

  4. Department of General Surgery, Cwm Taf University Health Board, Royal Glamorgan Hospital, Pontyclun, UK

    Shahab Hajibandeh

  5. General Surgery, Wales Deanery, Health Education and Improvement Wales, Nantgarw, UK

    Shahab Hajibandeh

Authors
  1. Karim Hassan
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  2. Sumera Baloch
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  3. Elsie Jia Zhi Tan
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  4. James Chamberlain
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  5. Ahsan Ashfaq
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  6. Jigar Shah
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  7. Shahin Hajibandeh
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  8. Shahab Hajibandeh
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Contributions

Conception and design: Shahab H. Data collection: all authors. Analysis and interpretation: all authors. Writing the article: all authors. Critical revision of the article: all authors. Final approval of the article: all authors. Statistical analysis: Shahab H, Shahin H.

Corresponding author

Correspondence to Shahab Hajibandeh.

Ethics declarations

Ethical approval

Considering the nature of this study, ethical approval was not required.

Conflict of interest

The authors declare no competing interests.

Human and animal rights

This study is a systematic review with meta-analysis of outcomes which does not include research directly involving human or animal participation.

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Considering the nature of this study, informed consent was not required.

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Appendix

Appendix

Search no

Search strategy†

#1

Wound protector : TI,AB,KW

#2

Wound near 2 protector : TI,AB,KW

#3

#1 OR #2

#4

Pancreatoduodenectomy : TI,AB,KW

#5

MeSH descriptor: [pancreatoduodenectomy ] explode all trees

#6

Whipple near 2 procedure: TI,AB,KW

#7

#4 OR #5 OR #6

#8

#3 AND #7

  1. †This search strategy was adopted for following databases: CINAHL, EMBASE, MEDLINE, CENTRAL, and Scopus

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Hassan, K., Baloch, S., Tan, E.J.Z. et al. The effect of intraoperative wound protector use on the risk of surgical site infections in patients undergoing pancreatoduodenectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 407, 459–468 (2022). https://doi.org/10.1007/s00423-021-02420-5

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  • DOI: https://doi.org/10.1007/s00423-021-02420-5

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