The role of saline irrigation prior to wound closure in the reduction of surgical site infection: a systematic review an
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REVIEW
Open Access
The role of saline irrigation prior to wound closure in the reduction of surgical site infection: a systematic review and metaanalysis Peter C. Ambe1,2* , Tanja Rombey3, Julian-Dario Rembe2, Johannes Dörner2, Hubert Zirngibl2 and Dawid Pieper3
Abstract Background: Surgical site infection (SSI) describes an infectious complication of surgical wounds. Although SSI is thought to be preventable, it still represents a major cause of morbidity and substantial economic burden on the health system. Wound irrigation (WI) might reduce the level of bacterial contamination, but current data on its role in reducing or preventing SSI is conflicting. Our aim was to investigate the effectiveness of WI with normal saline prior to wound closure for the reduction of SSI in patients undergoing abdominal surgery. Methods: We conducted a systematic literature search in MEDLINE, EMBASE, and CENTRAL from inception to present, and cross-checked the reference lists of all included primary studies and relevant systematic reviews. (Quasi-) randomized controlled trials (RCTs) investigating the rate of SSI when using normal saline vs. no irrigation prior to wound closure following abdominal surgery were included. Primary outcome was the rate of SSI, secondary outcome the mean length of hospital stay (LOS). Results: Four RCTs including a total of 1194 patients were included for analysis. All studies compared wound irrigation with normal saline with no wound irrigation prior to wound closure. Their risk of bias was moderate. The relative risk of developing a SSI was lower when wound irrigation with normal saline was performed prior to wound closure although the effect was not statistically significant (risk ratio 0.73, 95%-confidence level: 0.37 to 1.43). Similarly, there was no difference in the LOS amongst both intervention arms. Conclusion: This systematic review could not identify an advantage for routine irrigation of abdominal wounds with normal saline over no irrigation prior to wound closure in preventing or reducing the rate of SSI. Systematic review registration: PROSPERO registry number CRD42018082287. Keywords: Abdominal surgery, Normal saline, Surgical site infection, Wound infection, Wound irrigation
* Correspondence: [email protected] 1 Department of General Surgery, Visceral Surgery and Coloproctology, GFO Kliniken Rhein Berg Vinzenz-Pallotti-Hospital Bensberg, Vinzenz-Pallotti-Str. 20, 51429 Bergisch Gladbach, Germany 2 Department of Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are i
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