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Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis

  • Systematic Review and Meta-analysis
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Abstract

Purpose

Surgical site infection (SSI) remains to be one of the most frequent infectious complications following abdominal surgery. Prophylactic intra-operative wound irrigation (IOWI) before skin closure has been proposed to reduce bacterial wound contamination and the risk of SSI. However, current recommendations on its use are conflicting especially concerning antibiotic and antiseptic solutions because of their potential tissue toxicity and enhancement of bacterial drug resistances.

Methods

To analyze the existing evidence for the effect of IOWI with topical antibiotics, povidone-iodine (PVP-I) solutions or saline on the incidence of SSI following open abdominal surgery, a systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out according to the recommendations of the Cochrane Collaboration.

Results

Forty-one RCTs reporting primary data of over 9000 patients were analyzed. Meta-analysis on the effect of IOWI with any solution compared to no irrigation revealed a significant benefit in the reduction of SSI rates (OR = 0.54, 95 % confidence Interval (CI) [0.42; 0.69], p < 0.0001). Subgroup analyses showed that this effect was strongest in colorectal surgery and that IOWI with antibiotic solutions had a stronger effect than irrigation with PVP-I or saline. However, all of the included trials were at considerable risk of bias according to the quality assessment.

Conclusion

These results suggest that IOWI before skin closure represents a pragmatic and economical approach to reduce postoperative SSI after abdominal surgery and that antibiotic solutions seem to be more effective than PVP-I solutions or simple saline, and it might be worth to re-evaluate their use for specific indications.

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Acknowledgments

We thank Klaus-Peter Jannsen, PhD (Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany) for his advice regarding the writing of this manuscript.

Conflicts of interest

None.

Authors’ contributions

T. Mueller: Conception and design of study, literature review, data extraction, risk of bias evaluation, statistical analyses, draft of manuscript, writing and editing and submission of manuscript, and corresponding author

M. Loos: Conception and design of study, literature review, data extraction, risk of bias evaluation, statistical analyses, draft of manuscript, critical revision, and approval of final version

B. Haller: Conception and design of study, statistical analyses, revision and editing of manuscript, and approval of final version

A. Mihaljevic: Conception and design of study, consensus if TM and ML disagreed during literature review, data extraction or risk of bias evaluation, statistical analyses, draft of manuscript, revision and editing of manuscript, and approval of final version

U. Nitsche: Conception and design of study, revision and editing of manuscript draft, consensus if TM and ML disagreed during literature review, and approval of final version

H. Friess: Conception and design of study, critical revision and editing of manuscript draft, and approval of final version

J. Kleeff: Conception and design of study, critical revision and editing of manuscript draft, and approval of final version

F. Bader: Conception and design of study, revision and editing of manuscript, consensus during data extraction and risk of bias evaluation, and revision and approval of final manuscript version

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Authors and Affiliations

  1. Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Tara C. Mueller, Martin Loos, André L. Mihaljevic, Ulrich Nitsche, Dirk Wilhelm, Helmut Friess, Jörg Kleeff & Franz G. Bader

  2. Institute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany

    Bernhard Haller

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  1. Tara C. Mueller
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Mueller, T.C., Loos, M., Haller, B. et al. Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 400, 167–181 (2015). https://doi.org/10.1007/s00423-015-1279-x

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