Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands.
JAMA Surg. 2024 Jul 1;159(7):792-800. doi: 10.1001/jamasurg.2024.0775.
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.
To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.
PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.
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.
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.
The primary study outcome was SSI.
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).
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.
手术部位感染（SSI）是常见的术后并发症，与显著的发病率、死亡率和成本相关。术中预防性切口伤口冲洗用于降低 SSI 的风险，并且冲洗溶液的类型及其使用存在很大差异。
比较不同类型的预防性术中切口伤口冲洗在所有类型手术中预防 SSI 的效果。
截至 2023 年 6 月 12 日，检索了 PubMed、Embase、CENTRAL 和 CINAHL 数据库。
本研究纳入了比较切口预防性术中切口伤口冲洗与无冲洗或比较使用不同类型溶液冲洗的随机临床试验（RCT），以 SSI 为报告结果。排除了研究腔内灌洗的研究。
本系统评价和网络荟萃分析是根据系统评价和荟萃分析的首选报告项目进行报告的。两位审查员独立提取数据，并使用 Cochrane 风险偏倚 2 工具评估单个 RCT 中的风险偏倚，并使用推荐评估、制定和评估框架评估证据的确定性。进行了频率论网络荟萃分析，并报告了相对风险（RR）及其相应的 95%置信区间。
主要研究结果是 SSI。
共确定了 1587 篇文章，其中 41 项 RCT 纳入了系统评价，17188 名患者报告了 1328 例 SSI，总发生率为 7.7%。与无冲洗相比，抗菌溶液（RR，0.60；95%CI，0.44-0.81；高确定性）和抗生素溶液（RR，0.46；95%CI，0.29-0.73；低确定性）与 SSI 发生率降低相关。与无冲洗相比，生理盐水冲洗无统计学显著差异（RR，0.83；95%CI，0.63-1.09；中等确定性）。
本系统评价和网络荟萃分析发现，高确定性证据表明，使用抗菌溶液进行预防性术中切口伤口冲洗可降低 SSI 发生率。由于其结果的证据确定性较低以及全球抗菌药物耐药性问题，建议避免使用抗生素伤口冲洗。
