SLR - November 2022 - Megan Zainer, DPM
Effect of Wound Irrigation on the Prevention of Surgical Site Infections: A Meta-AnalysisReference: Chunmei Fu, Linghong Meng, Miguo Ma, Na Li, Jingcen Zhang. “Effect of Wound Irrigation on the Prevention of Surgical Site Infections: A Meta-Analysis.”(2022). International Wound Journal. Vol 19, Issue 7, Pg 1878-1886. https://doi.org/10.1111/iwj.13794
Level of Evidence: 2
Scientific Literature Review
Reviewed By: Megan Zainer DPM
Residency Program: Ascension SE Wisconsin
Podiatric Relevance: The risk of developing a surgical site infection (SSI) is up to 5% and has been documented as high as 10% in developing countries. SSI’s increase morbidity/mortality rates, extend hospital stays, and increase healthcare cost. Many surgeons use intraoperative irrigation - a simple intervention to dilute body fluid, bacteria, and cellular debris, but no standard guideline has been established. Additionally, many of the solutions used for irrigation are not approved for open incisions by the FDA. The purpose of this study was to compare efficacy of different wound irrigation on prevention of SSIs.
Methods: 24 studies met inclusion criteria with 4967 subjects. Interventional groups consisted of antibiotic irrigation and aqueous povidine/iodine vs. saline irrigation or no irrigation. Antibiotic irrigation was used in 1372, aqueous povidine/iodine in 1261, and saline/no irrigation in 2334. Inclusion criteria required that studies report the effect of wound irrigation on prophylaxis rather than for treatment.
Results: All studies evaluated the effect of wound irrigation on the prevention of surgical site infections. Antibiotic irrigation had significantly lower SSI compared with saline or no irrigation. Aqueous povidine/iodine irrigation also had significantly lower SSI in all populations compared with saline or no irrigation.
Conclusions: Overall, antibiotic and aqueous povidine/iodine irrigation had significantly lower surgical site infections in all populations compared with saline or no irrigation. Many studies have shown prophylactic incisional irrigation has significant value on SSI, mainly in clean and clean-contaminated wounds, however no dose-response effect has been detected. The present study, however, had significant limitations including small sample sizes, with 5 of the studies having <100 patients, age, gender, obedience, nutritional status, ethnicity. These factors were not considered and likely had an effect on SSI. The authors suggest further studies are essential to establish a clinically meaningful difference in results.