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Janet P. Edwards, MD, MPH, CPH,∗ Adelyn L. Ho, MD, MPH,† May C. Tee, MD, MPH,‡ Elijah Dixon, MD, MSc,∗
and Chad G. Ball, MD, MSc∗
Objective: A meta-analysis of randomized clinical trials (RCTs) was conducted
to evaluate whether wound protectors reduce the risk of surgical site
infection (SSI) after gastrointestinal and biliary tract surgery.
Background: The effectiveness of impervious wound edge protectors for
reduction of SSI remains unclear.
Methods: A systematic review was conducted in Medline, EMBASE, and
the Cochrane Library to identify RCTs that evaluate the risk of SSI after
gastrointestinal and biliary surgeries with and without the use of an impervious
wound protector. The pooled risk ratio was estimated with random-effect
meta-analysis. Sensitivity analyses were performed to examine the impact of
structural design of wound protector, publication year, study quality, inclusion
of emergent surgeries, preoperative antibiotic administration, and bowel
preparation on the pooled risk of SSI.
Results: Of the 347 studies identified, 6 RCTs representing 1008 patients
were included. The use of a wound protector was associated with a significant
decrease in SSI (RR = 0.55, 95% CI 0.31–0.98, P = 0.04). There was a
nonsignificant trend toward greater protective effect in studies using a dual
ring protector (RR = 0.31, 95% CI 0.14–0.67, P = 0.003), rather than a single
ring protector (RR = 0.83, 95% CI 0.38–1.83, P = 0.64). Publication year
(P=0.03) and blinding of outcome assessors (P=0.04) significantlymodified
the effect of wound protectors on SSI.
Conclusions: Our results suggest that wound protectors reduce rates of SSI
after gastrointestinal and biliary surgery.
(Ann Surg 2012;256:53–59)
Surgical site infections (SSI) are a common and costly source
of postoperative morbidity. They are the most common complications
experienced after gastrointestinal and biliary tract surgery,
occurring in 5% to 30% of patients.1,2 SSI are associated with a
twofold increased risk of in-hospital mortality, a 50% increase in intensive
care admission, a 6-day mean increase in hospital stay, and a
fivefold increased rate of readmission.3 The estimated increased cost
per SSI ranges from $1300 to $5000.3,4 In addition, patients who develop
SSI experience psychosocial distress, loss of income, and loss
of productivity.5 Prevention of SSI is therefore an important goal in
delivering quality care to patients.
Wound protectors are devices designed to protect the abdominal
wound edges from contamination and trauma during laparotomy.1
A major reason for their conception and use is a theoretical reduction
in risk of SSI. Various devices with similar intent have been described
Fromthe ∗Division of General Surgery,University of Calgary; †Divisions of Plastic
Surgery; and ‡General Surgery, University of British Columbia, Canada.
Disclosure: E.D. is supported by a Canadian Institutes of Health Research New
Investigator Award. The remaining authors have no financial disclosures. None
of the authors have any connectionwith themanufacturers of any of the products
described in this report.
Reprints:ChadG.Ball,MD,MSc, Department of Surgery and Oncology,University
of Calgary, Foothills Medical Center, 1403–29 StreetNW,Calgary,Alberta T2N
2T9, Canada. E-mail: ball.chad@gmail.com.
Copyright C 2012 by Lippincott Williams & Wilkins
ISSN: 0003-4932/12/25601-0053
DOI: 10.1097/SLA.0b013e3182570372
since the 1960s, falling into 2 main design categories: (1) those with
an internal and external ring connected by impervious plastic and
(2) those with a single, internal ring connected to a drape that extends
outward, over the wound edges and onto the abdomen where
they are affixed with adhesive or clips. The reduction of SSI afforded
by wound protectors is supported by several studies.2,6–13 However,
other studies have obtained null results.14–21 This discrepant evidence
leaves significant uncertainty in the surgical community with regard
to the efficacy of wound protectors in prevention of SSI.
The purpose of our study is to critically evaluate whether
wound protectors reduce the risk of SSI after gastrointestinal and
biliary tract surgery in a pooled analysis of randomized controlled
trials (RCTs). To our knowledge, this meta-analysis is the first to
address this important issue. Our secondary objectives are (1) to
investigate whether risk reduction varies with structural design of
wound protector, (2) to determine if the risk reduction is uniform
in studies addressing elective operations only, compared to those including
emergent surgeries, and (3) to determine if other factors such
as preoperative antibiotic use, bowel preparation, publication year, or
study quality are significant determinants of effect. The authors have
no conflicts of interest to disclose.
Wound protectors reduce surgical site infection a meta-analysis of randomized co.pdf
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发表于 2014-2-14 12:10
发表于 2014-2-14 12:15
