Ambe Peter C, Rombey Tanja, Rembe Julian-Dario, Dörner Johannes, Zirngibl Hubert, Pieper Dawid
Department of General Surgery, Visceral Surgery and Coloproctology, GFO Kliniken Rhein Berg Vinzenz-Pallotti-Hospital Bensberg, Vinzenz-Pallotti-Str. 20, 51429, Bergisch Gladbach, Germany.
Department of Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany.
Patient Saf Surg. 2020 Dec 22;14(1):47. doi: 10.1186/s13037-020-00274-2.
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.
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).
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.
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.
PROSPERO registry number CRD42018082287 .
手术部位感染（SSI）是指手术伤口的感染性并发症。尽管人们认为SSI是可以预防的，但它仍是发病的主要原因，并给卫生系统带来巨大经济负担。伤口冲洗（WI）可能会降低细菌污染水平，但目前关于其在减少或预防SSI方面作用的数据存在矛盾。我们的目的是研究在腹部手术患者伤口闭合前用生理盐水进行伤口冲洗以降低SSI的有效性。
我们对MEDLINE、EMBASE和CENTRAL数据库从建库至当前进行了系统文献检索，并交叉核对了所有纳入的原始研究和相关系统评价的参考文献列表。纳入了（准）随机对照试验（RCT），这些试验研究了腹部手术后伤口闭合前使用生理盐水冲洗与不冲洗时的SSI发生率。主要结局是SSI发生率，次要结局是平均住院时间（LOS）。
纳入四项RCT，共1194例患者进行分析。所有研究均比较了伤口闭合前用生理盐水冲洗伤口与不冲洗伤口的情况。其偏倚风险为中等。伤口闭合前用生理盐水冲洗伤口时发生SSI的相对风险较低，尽管该效果无统计学意义（风险比0.73，95%置信区间：0.37至1.43）。同样，两个干预组之间的住院时间无差异。
本系统评价未能发现腹部伤口在闭合前常规用生理盐水冲洗比不冲洗在预防或降低SSI发生率方面具有优势。
PROSPERO注册号CRD4201808
