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Wound protectors in reducing surgical site infections in lower gastrointestinal surgery: an updated meta-analysis

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Abstract

Background

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.

Methods

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.

Results

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%).

Conclusions

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.

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References

  1. Hubner M, Diana M, Zanetti G, Eisenring MC, Demartines N, Troillet N (2011) Surgical site infections in colon surgery: the patient, the procedure, the hospital, and the surgeon. Arch Surg 146(11):1240–1245

    Article  PubMed  Google Scholar 

  2. Blumetti J, Luu M, Sarosi G, Hartless K, McFarlin J, Parker B, Dineen S, Huerta S, Asolati M, Varela E, Anthony T (2007) Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 142(5):704–711

    Article  PubMed  Google Scholar 

  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):181–189

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 244(5):758–763

    Article  PubMed  PubMed Central  Google Scholar 

  5. Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF (2004) Wound infection after elective colorectal resection. Ann Surg 239(5):599–605

    Article  PubMed  PubMed Central  Google 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):61–69

    Article  PubMed  Google Scholar 

  7. Boni L, Benevento A, Rovera F, Dionigi G, Di Giuseppe M, Bertoglio C, Dionigi R (2006) Infective complications in laparoscopic surgery. Surg Infect 7:109–111

    Article  Google Scholar 

  8. Nakamura T, Mitomi H, Ihara A, Onozato W, Sato T, Ozawa H, Hatade K, Watanabe M (2008) Risk factors for wound infection after surgery for colorectal cancer. World J Surg 32(6):1138–1141

    Article  PubMed  Google Scholar 

  9. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20(4):250–278

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google 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):e95595

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. Zhang MX, Sun YH, Xu Z, Zhou P, Wang HX, Wu YY (2015) Wound edge protector for prevention of surgical site infection in laparotomy: an updated systematic review and meta-analysis. ANZ J Surg 85(5):308–314

    Article  PubMed  Google 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):1017–1029

    Article  PubMed  Google Scholar 

  17. NNIS System (2001) National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from January 1992 to June 2001, issued August 2001. Am J Infect Control 29(6):404–421

    Article  Google Scholar 

  18. Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J (2009) Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. J Hosp Infect 72(3):243–250

    Article  CAS  PubMed  Google 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 Collaboration

  21. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, GRADE Working Group (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926

    Article  PubMed  PubMed Central  Google 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:b2700

    Article  PubMed  PubMed Central  Google Scholar 

  23. Baier P, Kiesel M, Kayser C, Fischer A, Hopt UT, Utzolino S (2012) Ring drape do not protect against surgical site infections in colorectal surgery: a randomised controlled study. Int J Colorectal Dis 27:1223–1228

    Article  PubMed  Google Scholar 

  24. Cheng KP, Roslani AC, Sehha N, Kueh JH, Law CW, Chong HY, Arumugam K (2012) ALEXIS O-Ring wound retractor vs. conventional wound protection for the prevention of surgical site infections in colorectal resections. Colorectal Dis 14:e346–e351

    Article  CAS  PubMed  Google Scholar 

  25. Lauscher JC, Grittner F, Stroux A, Zimmermann M, le Claire M, Buhr HJ, Ritz JP (2012) Reduction of wound infections in laparoscopic-assisted colorectal resections by plastic wound ring drapes (REDWIL): a randomized controlled trial. Langenbecks Arch Surg 397:1079–1085

    Article  CAS  PubMed  Google Scholar 

  26. Nystrom PO, Broome A, Hojer H, Ling L (1984) A controlled trial of a plastic wound ring drape to prevent contamination and infection in colorectal surgery. Dis Colon Rectum 27(7):451–453

    Article  CAS  PubMed  Google Scholar 

  27. Reid K, Pockney P, Draganic B, Smith SR (2010) Barrier wound protection decreases surgical site infection in open elective colorectal surgery: a randomized clinical trial. Dis Colon Rectum 53(10):1374–1380

    Article  PubMed  Google Scholar 

  28. Horiuchi T, Tanishima H, Tamagawa K, Matsuura I, Nakai H, Shouno I, Tsubakihara H, Inoue M, Tabuse K (2007) Randomized, controlled investigation of the anti-infective properties of the Alexis retractor/protector of incision sites. J Trauma 62(1):212–215

    Article  PubMed  Google 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):730–739

    Article  PubMed  Google 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:f4305

    Article  PubMed  PubMed Central  Google Scholar 

  31. Psaila JV, Wheeler MH, Crosby DL (1977) The role of plastic wound drapes in the prevention of wound infection following abdominal surgery. Br J Surg 64(10):729–732

    Article  CAS  PubMed  Google Scholar 

  32. Williams JA, Oates GD, Brown PP, Burden DW, McCall J, Hutchison AG, Lees LJ (1972) Abdominal wound infections and plastic wound guards. Br J Surg 59(2):142–146

    Article  CAS  PubMed  Google 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):527–533

    Google Scholar 

  34. Lee P, Waxman K, Taylor B, Yim S (2009) Use of wound-protection system and postoperative wound-infection rates in open appendectomy: a randomized prospective trial. Arch Surg 144(9):872–875

    Article  Google 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):605–627

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Kingston General Hospital, 76 Stuart Street Victory 3, Kingston, ON, K7L 2V7, Canada

    Lisa Zhang & Sunil V. Patel

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Basheer Elsolh

Authors
  1. Lisa Zhang
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  2. Basheer Elsolh
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Contributions

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.

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Correspondence to Lisa Zhang.

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Disclosures

Drs. Lisa Zhang, Basheer Elsolh, and Sunil Patel have no conflict of interest or financial ties to disclose.

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Zhang, L., Elsolh, B. & Patel, S.V. Wound protectors in reducing surgical site infections in lower gastrointestinal surgery: an updated meta-analysis. Surg Endosc 32, 1111–1122 (2018). https://doi.org/10.1007/s00464-017-6012-0

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  • DOI: https://doi.org/10.1007/s00464-017-6012-0

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