Wound Irrigation for the Prevention of Surgical Site Infections: Systematic Review and Network Meta-Analysis

Author(s):
Nathan Bontekoning; Hannah Groenen; Hasti Jalalzadeh; Marja Boermeester

Background:

Surgical site infection (SSI) is one of the most common post-operative complications and is associated with significant morbidity and mortality. Prophylactic intra-operative wound irrigation (pIOWI) is widely used to reduce the risk of SSI. Nevertheless, a wide variation in irrigation solutions and application methods are currently used. Therefore, we aim to compare the efficacy of different types of incisional pIOWI in the prevention of SSI.

Hypothesis:

We hypothesize that any type of pIOWI will reduce the number of SSIs compared to no pIOWI.

Methods:

The PUBMED, Embase, CENTRAL and CINAHL databases were searched on November 21, 2022. We included randomized controlled trials (RCTs) comparing incisional pIOWI to either no pIOWI or incisional pIOWI using different types of solutions, with SSI as reported outcome. Studies investigating intra-peritoneal and mediastinal lavage were excluded. A frequentist network meta-analysis was conducted and relative risks (RR) with corresponding 95% confidence intervals (CI) were extracted.

Results:

We identified 1495 articles, of which 26 RCTs were included in the systematic review, with 11972 patients reporting 1084 SSIs; an overall incidence of 9.1%. Compared to saline wound irrigation, antibiotic irrigation (RR 0.28, 95% CI 0.11-0.71) and aqueous povidone-iodine irrigation (RR 0.49, 95% CI 0.28-0.86) showed significant benefit in reducing SSI. Additionally, no irrigation showed no significant difference compared to saline irrigation (RR 1.10, 95% CI 0.62-1.93).

Conclusions:

This network meta-analysis shows prophylactic intra-operative incisional wound irrigation using only an antibiotic or povidone-iodine solution is effective in reducing SSI.