Role of wound protectors in preventing surgical site infection in patients undergoing abdominal surgery: a meta-analysis of randomized controlled trials.

Abstract

Objective: To investigate the role of wound protectors (WPs) in surgical site infection (SSI) prevention in patients undergoing abdominal surgery.

Background: Despite practitioners having pursued the ultimate aim of "getting to zero" for centuries, SSI is still a global healthcare burden. WPs are thought to be able to prevent the incision from bacterial contamination, however, contradictory results have been reported.

Method: A meta-analysis was performed to compare the SSI rate in patients with and without WPs after abdominal surgery. It includes subgroup analysis of the SSI rate in different surgical sites and different degrees of wound contamination. A systematic literature search was conducted in the PubMed, Embase, Cochrane Library databases, and Web of Science from their respective inceptions until July 6, 2024. All randomized controlled trials with consistent definitions of SSI were included. The bias of each included RCT was assessed by using the Cochrane Risk of Bias 2. To evaluate the risks of random errors resulting from repeated significant testing, a trial sequential analysis was performed. The quality of evidence was assessed by using GRADEpro Guideline Development Tool.

Results: A total of 4779 participants were involved in the 19 RCTs. The results showed that the application of WPs during abdominal surgery could significantly reduce the SSI rate (RR = 0.63, 95% CI: 0.50-0.80, P = 0.0001, very low certainty evidence). Subgroup analysis showed that the implementation of WPs significantly reduced the SSI rate after colorectal and gastrointestinal surgery (RR = 0.58, 95% CI: 0.38-0.91, P = 0.02, very low certainty evidence; RR = 0.49, 95% CI: 0.36-0.67, P < 0.00001, moderate certainty evidence, respectively), while had no clear protect role in other types of abdominal surgery. The WPs significantly reduced the SSI rate in patients with a clean-contaminated wound (RR = 0.64, 95% CI: 0.46-0.89, P = 0.008, very low certainty evidence) and contaminated or dirty wound (RR = 0.61, 95% CI: 0.41-0.92, P = 0.02, moderate certainty evidence), respectively.

Conclusions: The results indicated that the WPs should not be used indiscriminately in all abdominal but gastrointestinal surgery. For patients with contaminated or dirty incisions, WPs should be considered. More studies are needed to determine the effect of WPs in laparoscopic surgery.

Clinical trial number: Not applicable.