Wound protectors in reducing surgical site infections in lower gastrointestinal surgery: an updated meta-analysis
- 461 Downloads
Surgical site infection (SSI) is a common complication in gastrointestinal surgery. Wound protection devices are being increasingly used in the attempt to reduce infection rates. We performed a meta-analysis to determine if wound protectors reduce the incidence of SSIs in lower gastrointestinal surgery.
MEDLINE and EMBASE databases were searched between 1946 and 2016. Randomized controlled trials comparing wound protector versus no wound protector in lower gastrointestinal surgery were included. Our primary outcome was surgical site infection. Subgroup analysis was conducted comparing single-ring versus dual-ring wound protectors.
Twelve RCTs with 3029 participants were included. There was a significant decrease in the odds of developing SSI in the wound protector group (OR 0.64, 95% CI 0.45–0.90, P < 0.01, I 2 = 55%). There was evidence of a subgroup effect (P = 0.01) with dual-ring wound protectors associated with significantly lower incidence of SSIs (OR 0.31, 95% CI 0.18–0.52, P < 0.0001, I 2 = 12%), which was not appreciated in the single-ring group (OR 0.84, 95% CI 0.67–1.04, P = 0.11, I 2 = 0%).
Wound protector use is associated with decreased odds of developing SSI in patients undergoing lower gastrointestinal surgery. There was a subgroup effect when comparing dual-ring to single-ring devices.
KeywordsSurgical site infection Wound infection Colorectal surgery Appendix Gastrointestinal surgery
LZ: acquisition, analysis, and interpretation of data, drafting of the article, revision of the article. BE: acquisition of data, drafting of the article, revision of the article. SVP: conception and design, analysis and interpretation of data, revision of the article. All authors had final approval of the article.
Compliance with ethical standards
Drs. Lisa Zhang, Basheer Elsolh, and Sunil Patel have no conflict of interest or financial ties to disclose.
- 3.Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY (2001) Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2809 consecutive patients. Ann Surg 234(2):181–189CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Degrate L, Garancini M, Misani M, Poli S, Nobili C, Romano F, Giordano L, Motta V, Uggeri F (2011) Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections. Int J Colorectal Dis 26(1):61–69CrossRefPubMedGoogle Scholar
- 11.Scott RD (2009) The direct medical costs of healthcare-associated infections in U.S. Hospitals and the benefits of prevention. http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. March 2009; Accessed 19 Nov 2016
- 12.Gheorghe A, Roberts TE, Pinkney TD, Bartlett DC, Morton D, Calvert M, West Midlands Research Collaborative, ROSSINI Trial Investigators (2014) The cost-effectiveness of wound-edge protection devices compared to standard care in reducing surgical site infection after laparotomy: an economic evaluation alongside the ROSSINI trial. PLoS ONE 9(4):e95595CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Gheorghe A, Calvert M, Pinkney TD, Fletcher BR, Bartlett DC, Hawkins WJ, Mak T, Youssef H, Wilson S, West Midlands Research Collaborative, ROSSINI Trial Management Group (2012) Systematic review of the clinical effectiveness of wound-edge protection devices in reducing surgical site infection in patients undergoing open abdominal surgery. Ann Surg 255(6):1017–1029CrossRefPubMedGoogle Scholar
- 19.Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions. http://handbook.cochrane.org. March 2011; Accessed 10 Oct 2016
- 20.Review Manager (RevMan) (2014) [Computer program] Version 5.3 Copenhagen: The Nordic Cochrane Centre, The Cochrane CollaborationGoogle Scholar
- 22.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Mihaljevic AL, Schirren R, Ozer M, Ottl S, Grun S, Michalski CW, Erkan M, Jager C, Reiser-Erkan C, Kehl V, Schuster T, Roder J, Clauer U, Orlitsch C, Hoffmann TF, Lange R, Harzenetter T, Steiner P, Michalski M, Henkel K, Stadler J, Pistorius GA, Jahn A, Obermaier R, Unger R, Strunk R, Willeke F, Vogelsang H, Halve B, Dietl KH, Hilgenstock H, Meyer A, Kramling HJ, Wagner M, Schoenberg MH, Zeller F, Schmidt J, Friess H, Jorg K (2014) Multicenter double-blinded randomized controlled trial of standard abdominal wound edge protection with surgical dressings versus coverage with a sterile circular polyethylene drape for prevention of surgical site infections: a CHIR-Net Trial (BaFO; NCT01181206). Ann Surg 260(5):730–739CrossRefPubMedGoogle Scholar
- 30.Pinkney TD, Calvert M, Bartlett DC, Gheorghe A, Redman V, Dowswell G, Hawkins W, Mak T, Youssef H, Richardson C, Hornsby S, Magill L, Haslop R, Wilson S, Morton D, West Midlands Research Collaborative, ROSSINI Trial Management Group (2013) Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI Trial). BMJ 347:f4305CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Silva A, Vargas G, Moreno A, Becerra P (2008) Use of an elastic wall retractor during appendectomy to reduce wound infection. Rev Chil Cir 60(6):527–533Google Scholar
- 35.Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist AC, Saiman L, Yokoe DS, Maragakis LL, Kaye KS (2014) Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35(6):605–627CrossRefPubMedPubMedCentralGoogle Scholar