Intraoperative wound irrigation to prevent surgical site infection: A systematic review and meta-analysis.

Autor: Filardi KFXC; Department of Surgery, Division of Digestive Surgery, University of São Paulo, São Paulo, Brazil., Wegner GRM; Universidade Federal da Fronteira do Sul, Chapeco, Brazil., Dos Santos AB; Sírio Libanês Hospital, Sao Paulo, Brazil., Filardi RGM; University of São Paulo, Sao Paulo, Brazil., Vasques LF; University Catholic of Pelotas, Pelotas, Brazil., Massoni MC; Bahiana School of Medicine and Public Health, Salvador, Brazil., Da Costa MPC; University Center Assis Gurgacz Foundation, Cascavel, Brazil.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2024 Oct; Vol. 48 (10), pp. 2400-2412. Date of Electronic Publication: 2024 Sep 11.
DOI: 10.1002/wjs.12339
Abstrakt: Introduction: The potential benefit of intraoperative wound irrigation (IOWI) in preventing surgical site infection (SSI) remains unclear. The use of antimicrobial agents (AMA) or antiseptic agents (ASA) is controversial worldwide.
Methods: We performed a systematic review and meta-analysis of randomized clinical trials comparing AMA or ASA with saline solution in patients who underwent abdominal surgery. Sub-analyses were performed on the type of surgery, type of intervention agent, and wound classification.
Results: Nineteen studies comprising 4915 patients undergoing abdominal surgery were included. SSI was observed in 207 out of 2504 patients in the intervention group (8.26 %) and 344 out of 2411 patients in the control group (14.27%). Overall, intraoperative wound irrigation (IOWI) with AMA or ASA was associated with a lower SSI (Odds ratio (OR) 0.62; 95% CI 0.47, 0.82; p < 0.01; I 2  = 50%). Sub-analyses have shown a tendency for decreased SSI in patients from emergency surgery (OR 0.46; 95% CI 0.30, 0.70; p < 0.01; I 2  = 23%), patients with contaminated wound (OR 0.48; 95% CI 0.31, 0.74; p < 0.01; I 2  = 24%), and either the use of AMA or ASA (OR 0.53 vs. 0.65).
Conclusion: The overall use of AMA or ASA before skin closure was associated with decreased SSI. Lower rates of SSI were observed in the subgroup analysis. Furthermore, we must consider the critical heterogeneity of the studies.
(© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
Databáze: MEDLINE
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