Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 1;159(7):792-800.
doi: 10.1001/jamasurg.2024.0775.

Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis

Hannah Groenen  1   2   3 , Nathan Bontekoning  1   2   3 , Hasti Jalalzadeh  1   2   3 , Dennis R Buis  3   4 , Yasmine E M Dreissen  3   4 , Jon H M Goosen  3   5 , Haitske Graveland  3 , Mitchel Griekspoor  3   6 , Frank F A IJpma  3   7 , Maarten J van der Laan  3   8 , Roald R Schaad  3   9   10 , Patrique Segers  3   11 , Wil C van der Zwet  3   12 , Ricardo G Orsini  13 , Anne M Eskes  1   14 , Niels Wolfhagen  1   2   3 , Stijn W de Jonge  1   2 , Marja A Boermeester  1   2   3
Affiliations

Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis

Hannah Groenen et al. JAMA Surg. .

Abstract

Importance: Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.

Objective: To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.

Data sources: PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.

Study selection: Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.

Data extraction and synthesis: This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.

Main outcome and measure: The primary study outcome was SSI.

Results: A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).

Conclusions and relevance: This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Eskes reported receiving grants from ZonMw outside the submitted work. Dr Boermeester reported receiving grants from J&J and 3M and speaker and/or instructor fees from J&J, 3M, BD, Gore, Smith & Nephew, TelaBio, Angiodynamics, GDM, Medtronic, and Molnycke outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flowchart of Study Selection
Figure 2.
Figure 2.. Network Graph of the 41 Randomized Clinical Trials Included in the Network Meta-Analysis
The network graph shows the number of studies investigating the direct comparison of the different methods of prophylactic intraoperative incisional wound irrigation for the prevention of surgical site infections. The size of the nodes and the thickness of the lines correspond with the number of studies.
Figure 3.
Figure 3.. Forest Plot of the Outcomes of Different Wound Irrigation Solutions
The forest plot shows the outcomes of different wound irrigation solutions in the prevention of surgical site infections compared with no irrigation. Data are relative risk (RR) with corresponding 95% CI.
Figure 4.
Figure 4.. League Table of All Pairwise Comparisons in the Network Meta-Analysis
The league table is a square matrix showing all pairwise comparisons in the network meta-analysis. In the lower triangle of the league table, the network relative risks (RRs) with corresponding 95% CIs are shown. The upper triangle shows the RRs of only the direct comparisons (comparable with a regular pairwise meta-analysis). For instance, the first column (in the lower triangle) shows the network RR with corresponding 95% CI of antibiotic compared with the other irrigation solutions. The last column (upper triangle) shows the direct RR with corresponding 95% CI of no irrigation compared with the other irrigation solutions.
See this image and copyright information in PMC

Comment in

References

    1. Gillespie BM, Harbeck E, Rattray M, et al. . Worldwide incidence of surgical site infections in general surgical patients: a systematic review and meta-analysis of 488 594 patients. Int J Surg. 2021;95:106136. doi:10.1016/j.ijsu.2021.106136 - DOI - PubMed
    1. Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on health care costs and patient outcomes: a systematic review in 6 European countries. J Hosp Infect. 2017;96(1):1-15. doi:10.1016/j.jhin.2017.03.004 - DOI - PubMed
    1. Papadakis M. Wound irrigation for preventing surgical site infections. World J Methodol. 2021;11(4):222-227. doi:10.5662/wjm.v11.i4.222 - DOI - PMC - PubMed
    1. National Institute for Health and Care Excellence . Surgical site infections: prevention and treatment. Accessed August 1, 2023. https://www.nice.org.uk/guidance/ng125 - PubMed
    1. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. ; Healthcare Infection Control Practices Advisory Committee . Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 - DOI - PubMed

Publication types

MeSH terms

Substances