Laurens Schattenkerk

25 The incidence of abdominal surgical site infections after abdominal birth defects surgery in infants Chapter 2 Introduction Surgical site infection (SSI) following abdominal birth defect surgery are a frequent and significant clinical problem which has been understudied in infants (under three years of age) who have been operated because of abdominal birth defects. Different forms of SSIs exist, namely wound infection, wound dehiscence, anastomotic leakage, post-operative peritonitis and fistula development. These complications may lead to longer hospital stay, increased medical costs, affect the quality of life and increase mortality rates.[25-28] Operations during the infantile years might lead to an increase in SSI risk.[29, 30] However, due to the rarity of most birth defects, the incidences of the different forms of SSI are not well known. Increased knowledge on the incidence of SSI would provide context for clinical decision-making and could serve as a starting point for future research. Determining which birth defects have the highest incidence of these SSIs might, for instance, allow targeted prophylactic antibiotics in order to minimize these risks. Therefore, this review aims to determine the incidence of the different surgical site infections for each abdominal birth defect surgery in infants by means of a meta-analysis. Methods Studies were selected using the criteria described below. They are based on the PRISMA Guidelines.[31] We registered our protocol in the International Prospective Register of Systematic Reviews (PROSPERO) on 7 March 2019 (registration number: CRD42019119268). Participants All studies reporting on SSIs after abdominal surgery of birth defect in infants operated within three years of age were considered eligible for this review. Studies done in animals, in vitro, non-English, conference abstracts and studies containing less than ten cases were excluded. Search strategy To identify all relevant publications, we conducted systematic searches in the bibliographic databases PubMed and Embase from inception up to February 2020 using both simple search terms as well as hierarchical family forms (e.g. MESH). Our institutions clinical data expert (RV) helped design the search strategy. This search combined four groups of search terms and their equivalents: (1) terms related to the age at the moment of surgery (e.g. neonate); (2) terms related to the location of surgery (e.g. intestinal surgery); (3) terms related to congenital abdominal defects (e.g. anorectal malformations); (4) terms related

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