The clinical effectiveness of wound edge protectors in reducing surgical site infection after abdominal surgery: meta-analysis

Abstract

Background Surgical site infection (SSI) is a common complication after abdominal surgery. The effectiveness of wound edge protectors in reducing infection of the surgical sites is still unclear. The purpose of this study was to determine the clinical effectiveness of a wound edge protector (WEP) in reducing SSI rates after abdominal surgery. Methods PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched to obtain relevant articles published up to September 2021. Publications were retrieved if they contain primary data on the use of WEPs in reducing SSI compared with standard care in patients undergoing abdominal surgery. Subgroup analyses were performed for different WEP types, surgical sites, and levels of contamination. The outcome of interest was a clinically defined SSI. Qualitative variables were pooled using risk ratios (RRs). Results Twenty-two eligible randomized clinical trials involving 4492 patients were included in this meta-analysis. WEP was associated with the reduced incidence of overall SSI (RR = 0.66; 95 per cent c.i. 0.53 to 0.83; P = 0.0003), and superficial SSI (RR = 0.59; 95 per cent c.i. 0.38 to 0.91; P = 0.02). In addition, WEP also successfully reduced the risk of SSI in clean-contaminated wounds (RR = 0.61; 95 per cent c.i. 0.40 to 0.93; P = 0.02) as well as in contaminated wounds (RR = 0.47; 95 per cent c.i. 0.33 to 0.67; P < 0.0001); however, WEP did not reduce SSI incidence in colorectal surgery (RR = 0.68; 95 per cent c.i. 0.46 to 1.01; P = 0.05). Conclusion This study suggests that WEP was efficient in reducing superficial SSI. Both double-ringed and single-ringed devices were efficient in reducing SSI. WEP was effective in reducing SSI incidence in clean-contaminated and contaminated surgery; however, its use does not reduce the SSI rate in colorectal surgery.

Effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery: A meta‐analysis

“…This was suggested also in a previous similar meta‐analyses study which showed similar promising outcomes for wound protectors in improving the surgical site wound infection and reducing the dual‐ring wound protectors. 6 , 7 , 8 Well‐conducted randomised controlled trials are needed to assess these factors and the combination of different gender, ages, ethnicity and other variants of subjects; because our meta‐analysis study could not answer whether different gender, ages and ethnicity are related to the results.…”

“…The expense of these kinds of gadgets is a deterrent to their widespread use 5 . The efficiency of wound protectors in reducing surgical site wound infections in abdominal surgeries has been the subject of multiple meta‐analyses published recently 6‐8 . In lower gastrointestinal surgery, there is not a published meta‐analysis that focuses solely on wound protectors.…”

“… 5 The efficiency of wound protectors in reducing surgical site wound infections in abdominal surgeries has been the subject of multiple meta‐analyses published recently. 6 , 7 , 8 In lower gastrointestinal surgery, there is not a published meta‐analysis that focuses solely on wound protectors. Contrary to the majority of other surgeries, these procedures are clean‐contaminated or contaminated, which are linked to a greater incidence of surgical site wound infections.…”

Preparing the Bowel (Microbiome) for Surgery: Surgical Bioresilience

“…For example, analyses of OA have compared their effectiveness against intravenous antibiotics alone, 11 or studied them in combination with mechanical bowel preparation and compared them to MBP 11 or no MBP, respectively. 12 Many early trials were also of poor quality and recruited heterogeneous patient cohorts with both benign and malignant disease undergoing both open and minimally invasive surgical procedures ( Table 1 ).…”

Surgical Site Infections—Time to Test Cost-Effective Prevention Strategies?

“…Among 41 randomized patients, those using the retractor experienced a significant reduction in SSIs compared with the nonretractor group, with statistical analysis supporting its effectiveness (odds ratio, 8.5; P = .03). A 2022 meta-analysis by Li et al, 5 including 22 randomized clinical trials with 4492 patients, showed wound-edge protector dev ices effectively decreased SSI in clean-contaminated and contaminated surgical procedures.…”