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. 2016 Mar 22:5:6.
doi: 10.1186/s13741-016-0030-7. eCollection 2016.

A systematic review and meta-analysis of perioperative oral decontamination in patients undergoing major elective surgery

Philip Spreadborough  1 , Sarah Lort  1 , Sandro Pasquali  2 , Matthew Popplewell  1 , Andrew Owen  3 , Irene Kreis  4 , Olga Tucker  5 , Ravinder S Vohra  6 ; Preventing Postoperative Pneumonia Study Group and the West Midlands Research Collaborative
Affiliations

A systematic review and meta-analysis of perioperative oral decontamination in patients undergoing major elective surgery

Philip Spreadborough et al. Perioper Med (Lond). .

Abstract

Background: Oral antiseptics reduce nosocomial infections and ventilator-associated pneumonia in critically ill medical and surgical patients intubated for prolonged periods. However, the role of oral antiseptics given before and after planned surgery is not clear. The aim of this systematic review and meta-analysis is to determine the effect of oral antiseptics (chlorhexidine or povidone-iodine) when administered before and after major elective surgery.

Methods: Searches were conducted of the MEDLINE, EMBASE and Cochrane databases. The analysis was performed using the random-effects method and the risk ratio (RR) with 95 % confidence interval (CI).

Results: Of 1114 unique identified articles, perioperative chlorhexidine was administered to patients undergoing elective surgery in four studies. This identified 2265 patients undergoing elective cardiac surgery, of whom 1093 (48.3 %) received perioperative chlorhexidine. Postoperative pneumonia and nosocomial infections were observed in 5.3 and 20.2 % who received chlorhexidine compared to 10.4 and 31.3 % who received a control preparation, respectively. Oral perioperative chlorhexidine significantly reduced the risk of postoperative pneumonia (RR = 0.52; 95 % CI 0.39-0.71; p < 0.01) and overall nosocomial infections (RR = 0.65; 95 % CI 0.52-0.81; p < 0.01), with no effect on in-hospital mortality (RR = 1.01; 95 % CI 0.49-2.09; p = 0.98).

Conclusions: Perioperative oral chlorhexidine significantly decreases the incidence of nosocomial infection and postoperative pneumonia in patients undergoing elective cardiac surgery. There are no randomised controlled studies of this simple and cheap intervention in patients undergoing elective non-cardiac surgery.

Trial registration: This systematic review was registered with the International prospective register of systematic reviews (PROSPERO). The registration number is CRD42015016063.

Keywords: Anti-infective agents; Chlorhexidine; Perioperative care; Pneumonia.

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Figures

Fig. 1
Fig. 1
CONSORT flow diagram of articles included in the systematic review
Fig. 2
Fig. 2
Forest plot comparing postoperative pneumonia in patients with or without chlorhexidine cover. A Mantel–Haenszel random-effects model was used for meta-analysis. Risk ratios are shown with 95 % confidence interval
Fig. 3
Fig. 3
Forest plot comparing nosocomial infections in patients with or without chlorhexidine cover. A Mantel–Haenszel random-effects model was used for meta-analysis. Risk ratios are shown with 95 % confidence interval
Fig. 4
Fig. 4
Forest plot comparing in-hospital mortality in patients with or without chlorhexidine cover. A Mantel–Haenszel random-effects model was used for meta-analysis. Risk ratios are shown with 95 % confidence interval
See this image and copyright information in PMC

References

    1. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139–144. doi: 10.1016/S0140-6736(08)60878-8. - DOI - PubMed
    1. Hemmes SN, Gama de Abreu M, Pelosi P, Schultz MJ, PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014;384:495–503. doi: 10.1016/S0140-6736(14)62030-4. - DOI - PMC - PubMed
    1. Niggebrugge AH, Trimbos JB, Hermans J, Steup WH, Van De Velde CJ. Influence of abdominal-wound closure technique on complications after surgery: a randomised study. Lancet. 1999;353:1563–1567. doi: 10.1016/S0140-6736(98)10181-2. - DOI - PubMed
    1. Treschan TA, Kaisers W, Schaefer MS, Bastin B, Schmalz U, Wania V, et al. Ventilation with low tidal volumes during upper abdominal surgery does not improve postoperative lung function. Br J Anaesth. 2012;109:263–271. doi: 10.1093/bja/aes140. - DOI - PubMed
    1. Seiler CM, Deckert A, Diener MK, Knaebel HP, Weigand MA, Victor N, et al. Midline versus transverse incision in major abdominal surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227) Ann Surg. 2009;249:913–920. doi: 10.1097/SLA.0b013e3181a77c92. - DOI - PubMed

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