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Prophylactic intraoperative wound irrigation with antibiotic solution for the prevention of surgical incisional wound infections: Systematic literature review and meta-analysis

  • Young Woong Mo
    Affiliations
    Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea

    Institute for Human Tissue Restoration, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
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  • Jae Hyeok Choi
    Affiliations
    Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea

    Institute for Human Tissue Restoration, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
    Search for articles by this author
  • Won Jai Lee
    Correspondence
    Corresponding author at: Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
    Affiliations
    Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea

    Institute for Human Tissue Restoration, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
    Search for articles by this author
Published:October 17, 2022DOI:https://doi.org/10.1016/j.bjps.2022.10.014

      Summary

      Background

      There is no consensus on the use of prophylactic intraoperative wound irrigation (pIOWI) for reducing surgical-site infections (SSIs), particularly surgical incisional wounds, and opinions are divided on whether an antibiotic should be mixed with the solution used for incisional wound irrigation. No large, reliable cohort studies or meta-analyses of pIOWI for surgical incisional wounds were found in PubMed or Embase.

      Methods

      We searched the PubMed, Embase, Cochrane Library, Insight, Scopus, and Web of Science databases for primary research articles investigating the relevance of pIOWI with antibiotics for SSIs. The initial search was limited to human studies published before January 2022, which were indexed as randomized controlled trials (RCTs); clinical trials; or observational, cross-sectional, or cohort studies. We used R statistical software version 4.1.2 for this meta-analysis.

      Results

      The odds ratio of the random-effects model was 0.519 [95% confidence interval (CI); 0.311, 0.864, P-value < 0.0117], indicating that the intervention had a statistically significant effect on surgical complications. To examine the heterogeneity of the entire study, we performed statistical analysis (τ2 (tau square) = 0.4175 [0.0732; 2.8178]; τ (tau) = 0.6461 [0.2706; 1.6786]; Higgins’ I2 = 64.0% [34.8%; 80.1%]; and H = 1.67 [1.24; 2.24]).

      Conclusions

      Many studies have shown that inclusion of antibiotics in the irrigation solution significantly lowers the rate of soft-tissue-related SSIs, but those studies contain both heterogeneity and many biases. Further large, prospective RCTs only limited to incisional SSIs and excluding other variables and biases in the field of plastic surgery are needed.

      Keywords

      Abbreviations:

      pIOWI (prophylactic intraoperative wound irrigation), SSI (surgical site infection), RCT (randomized controlled trial), OR (odds ratio), IOWI (intraoperative wound irrigation), CDC (Centers for Disease Control and Prevention), CI (confidence interval), SMD (standardized mean difference), MINORS (Methodological Index for Nonrandomized Studies), CHX (chlorhexidine), MRSA (methicillin-resistant Staphylococcus aureus), VRE (vancomycin-resistant enterococci), HIV (human immunodeficiency virus)
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