Systematic Review And Meta-Analysis Of Randomized Controlled Trials Evaluating Intra-operative Wound Irrigation For The Prevention Of Surgical Incision Infections After Type ? Abdominal Surgery

Objective Surgical site infectio n is one of the most frequent infectious complicat io ns following abdominal surgery.It not only increases the patient's time of hospitaliza t io n and economic burden,but also greatly increases the mental and psychological burden of the patient.Prophylactic intra-operative wound irrigation(IOWI)before skin closure has been proposed to reduce bacterial wound contamination and the risk of SSI.However,current recommendations on its use are conflicting especially concerning antibiotic and antiseptic solutions because of their potential tissue toxicity and enhancement of bacterial drug resistances.Therefore,it is still controversial whether IOWI can reduce the incidence of SSI.The operative incision is divided into four categories,including I,II,III and IV.Abdominal surgery can cover four incision,but type II surgical incision is the most common clinically.In order to reduce the heterogeneity of the sample,We only choose the sample that are abdominal type II surgical incision,and data were analyzed statistically.The purpose of this article is to evaluate the effect of IOWI on abdominal type II surgical incision infection and to provide evidence for clinical practice by using of evidence-based medicine.Methods Search"Irrigation/lavage","Surgical wound infection"and"randomized controlled trial/RC T",etc as key words and free words in SinoMed,WanFang,CN K I,WeiPu,Pubmed,Embase,Cochrane Library database before December 31,2017 and finding literature about abdominal type II incision surgery.According to Cochrane risk bias assessment tool to evaluate the quality of the included literature.Included literat ure will be divided into Group A(irrigation vs no irrigation)and Group B(Topical Anti-Infective Agents irrigation vs normal saline rinse irrigation).Meta-analyses were performed,and odds ratios(OR)and the mean difference with 95%confidence interva ls(CI)were extracted and pooled with a fixed or random effect model.The funnel plot was used to analyze the publication bias.The heterogeneity was analyzed by I~2 statistic test.The clinical significance was analyzed by the forest map,and finally going on the sensitivity analysis.Results There were 25 RCTs included in the literature.There were 16 articles in group A(including3560 patients),and 9 in group B(including 1706 patients).The results of Meta-analysis in group A showed that PVP-I irrigation can reduced the incidence of type II surgical incision infection after abdominal surgery statistically significantly[OR=0.56,95%CI(0.35,0.90),P=0.02<0.05],but saline irrigation can't reduced the incidence of class?surgical incision infection after abdominal surgery[OR=1.00,95%CI(0.61,1.62),P=0.99>0.05].The results of Meta-analysis in group B showed that the use of both antibiotics and PVP-I can reduced the incidence of type II surgical incision infection after abdominal surgery statistically significantly[OR=0.27,95%CI(0.18,0.41),P<0.00001].There was a publication bias in the group A.The heterogeneity of the two groups was within the acceptable range,and the final sensitivity analysis was also relatively stable.Conclusion In clinical,PVP-I irrigation can reduce the incidence of SSI after type II abdominal surgery,but saline irrigation can't reduce the incidence of surgical site infection.Although local antibiotic irrigation can reduce the incidence of SSI,it is not recommended for clinical because of its potential hazards.