دورية أكاديمية
Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis.
| العنوان: | Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis. |
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| المؤلفون: | Groenen H; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands.; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands., Bontekoning N; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands.; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands., Jalalzadeh H; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands.; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands., Buis DR; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands.; Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands., Dreissen YEM; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands.; Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands., Goosen JHM; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands.; Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, the Netherlands., Graveland H; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands., Griekspoor M; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands.; Dutch Association of Medical Specialists, Utrecht, the Netherlands., IJpma FFA; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands.; Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, Groningen, the Netherlands., van der Laan MJ; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands.; Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands., Schaad RR; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands.; Department of Anaesthesiology, Leiden University Medical Centre, Leiden, the Netherlands.; Dutch Association of Anaesthesiology (NVA), the Netherlands., Segers P; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands.; Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands., van der Zwet WC; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands.; Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center+, Maastricht, the Netherlands., Orsini RG; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands., Eskes AM; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Public Health, Amsterdam, the Netherlands., Wolfhagen N; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands.; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands., de Jonge SW; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands., Boermeester MA; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands.; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands. |
| المصدر: | JAMA surgery [JAMA Surg] 2024 Jul 01; Vol. 159 (7), pp. 792-800. |
| نوع المنشور: | Journal Article; Systematic Review; Meta-Analysis; Comment |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101589553 Publication Model: Print Cited Medium: Internet ISSN: 2168-6262 (Electronic) Linking ISSN: 21686254 NLM ISO Abbreviation: JAMA Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago, IL : American Medical Association, [2013]- |
| مواضيع طبية MeSH: | Surgical Wound Infection*/prevention & control , Therapeutic Irrigation*/methods , Network Meta-Analysis*, Humans ; Anti-Infective Agents, Local/administration & dosage ; Anti-Infective Agents, Local/therapeutic use ; Randomized Controlled Trials as Topic |
| مستخلص: | Importance: Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use. Objective: To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery. Data Sources: PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023. Study Selection: Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded. Data Extraction and Synthesis: This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported. Main Outcome and Measure: The primary study outcome was SSI. Results: A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty). Conclusions and Relevance: This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns. |
| التعليقات: | Comment on: JAMA Surg. 2024 Jul 1;159(7):800. doi: 10.1001/jamasurg.2024.0784. (PMID: 38656353) |
| المشرفين على المادة: | 0 (Anti-Infective Agents, Local) |
| تواريخ الأحداث: | Date Created: 20240424 Date Completed: 20240710 Latest Revision: 20240712 |
| رمز التحديث: | 20240713 |
| مُعرف محوري في PubMed: | PMC11044014 |
| DOI: | 10.1001/jamasurg.2024.0775 |
| PMID: | 38656408 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2168-6262 |
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| DOI: | 10.1001/jamasurg.2024.0775 |