wetenschapsdag 2023 | 97 Sessie 3c: Zing, Vecht, Huil, Bid, Lach, Werk en Bewonder x1 Auteurs N. Bontekoning*,H. Groenen*, H. Jalalzadeh, S.W. de Jonge, R.G. Orsini, A.M. Eskes, N. Wolfhagen, M.A. Boermeester Abstract titel Network meta-analysis on incisional wound irrigation for the prevention of surgical site infection Background Surgical site infections (SSI) are common post-operative complications and associated with significant morbidity, mortality, and costs. Prophylactic intra-operative incisional wound irrigation (IOWI) is used to reduce the risk of SSI. There is great variation in irrigation solutions and use. Therefore, we aimed to compare the efficacy of different types of incisional IOWI for the prevention of SSI. Methods PUBMED, Embase, CENTRAL and CINAHL databases were searched up to June 12, 2023. We included randomised controlled trials (RCTs) comparing incisional IOWI to no IOWI or comparing incisional IOWI using different types of solutions, with SSI as reported outcome. Studies investigating intra-cavity lavage were excluded. A frequentist network meta-analysis was conducted and relative risks (RR) with corresponding 95% confidence intervals (CI) were reported. Results We identified 1587 articles, of which 41 RCTs were included in the systematic review, with 17,188 patients reporting 1328 SSI; an overall incidence of 7.7%. Compared to no irrigation, antibiotic solutions (RR 0.46, 95% CI 0.29-0.73; high level of certainty) and antiseptic solutions (RR 0.60, 95% CI 0.44-0.81; moderate level of certainty) showed benefit in reducing SSI. Saline solution showed no statistically significant difference compared to no irrigation (RR 0.83, 95% CI 0.63-1.09). Conclusion This network meta-analysis shows that prophylactic intra-operative incisional wound irrigation with antibiotic or antiseptic solutions are effective in reducing SSI. Although antibiotic solutions are effective, use of antiseptic solutions is preferred considering rising antibiotic resistance.
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