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Wound edge protector for prevention of surgical site infection in laparotomy: an updated systematic review and meta‐analysis
Author(s) -
Zhang MingXia,
Sun YiHui,
Xu Zheng,
Zhou Ping,
Wang HongXia,
Wu YongYou
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12997
Subject(s) - medicine , randomized controlled trial , laparotomy , meta analysis , relative risk , surgery , surgical site infection , incidence (geometry) , confidence interval , physics , optics
Background An updated meta‐analysis based on randomized controlled trials ( RCT s) was conducted to evaluate the efficacy of wound edge protector ( WEP ) in the prevention of surgical site infection ( SSI ) in patients undergoing laparotomies. Methods Meta‐analysis was conducted using R eview M anager 5.2. The pooled risk ratio was estimated with random‐effect model. M edline, E mbase, the C ochrane library, reference lists and conference proceedings were data sources. Two independent reviewers screened studies for inclusion and data extraction. Eligible trials were RCT s enrolling patients accepting laparotomies to assess the effectiveness of WEP . Results Eleven RCT s totalling 2344 patients met the inclusion criteria. Six trials (1589 patients) testing the single‐ring design WEP did not show a statistically significant reduction in SSI of laparotomy ( RR 0.76, 95% CI 0.51–1.12). Pooled analysis of the five trials (755 patients) that tested the effect of dual‐ring design WEP on SSI showed a significant reduction ( RR 0.29, 95% CI 0.15–0.55). The combined data of the 11 trials favoured the effect of WEP ( RR 0.58, 95% CI 0.39–0.87). Analysis adjusted by the degrees of contamination revealed that WEP is effective in reducing the incidence of SSI after laparotomy of contamination incision ( RR 0.43, 0.26–0.72) but failed to demonstrate such effect in clean/contaminated and dirty incisions ( RR 0.72, 95% CI 0.43–1.21; RR 0.82, 95% CI 0.43–1.55, respectively). Conclusions Our exploratory meta‐analysis suggests that WEP reduces the incidence of SSI in patients receiving laparotomies, especially in the circumstance of dual‐ring WEP and in contaminated incisions. In order to fully assess the effectiveness of WEP , large‐scale and well‐designed RCT s are still needed in the future.