Wound Edge Protectors in Open Abdominal Surgery to Reduce Surgical Site Infections: A Systematic Review and Meta-Analysis

<div><p>Importance</p><p>Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality.</p><p>Objective</p><p>To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections.</p><p>Evidence Review</p><p>A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted.</p><p>Findings</p><p>We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I² = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I² = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I² = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I² = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I² = 72%).</p><p>Conclusions and Relevance</p><p>Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to explore their effectiveness in different risk constellations.</p></div

DataSheet_1_Gastrectomy for cancer beyond life expectancy. A comprehensive analysis of oncological gastric surgery in Germany between 2008 and 2018.pdf

IntroductionMajor gastric surgery for distal esophageal and gastric cancer has a strong impact on the quality of life, morbidity, and mortality. Especially in elderly patients reaching their life expectancy, the responsible use and extent of gastrectomy are imperative to achieve a balance between harm and benefit. In the present study, the reimbursement database (German Diagnosis Related Groups (G-DRG) database) of the Statistical Office of the Federal Republic of Germany was queried to evaluate the morbidity and mortality of patients aged above or below 75 years following gastrectomy.Material and methodsAll patients in Germany undergoing subtotal gastrectomy (ST), total gastrectomy (T), or gastrectomy combined with esophagectomy (TE) for gastric or distal esophageal cancer (International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) C15.2, C15.5, and C16.0–C16.9) between 2008 and 2018 were included. Intraoperative and postoperative complications as well as comorbidities, in-hospital mortality, and the extent of surgery were assessed by evaluating ICD-10 and operation and procedure key (Operationen- und Prozedurenschlüssel) codes.ResultsA total of 67,389 patients underwent oncologic gastric resection in Germany between 2008 and 2018. In total, 21,794 patients received ST, 41,825 received T, and 3,466 received TE, respectively. In 304 cases, the combinations of these, in fact, mutually exclusive procedures were encoded. The proportion of patients aged 75 years or older was 51.4% (n = 11,207) for ST, 32.6% (n = 13,617) for T, and 28.1% (n = 973) for TE. The in-hospital mortality of elderly patients was significantly increased in all three groups. (p ConclusionThe clinical outcome of major oncological gastric surgery is highly dependent on a patient’s age. The elderly show a tremendously increased likelihood of in-hospital mortality and morbidity.</p

Search strategy for MEDLINE via OvidSP.

<p>Search strategy for MEDLINE via OvidSP.</p

Additional file 1: of Parenteral nutrition during neoadjuvant chemotherapy for patients with non-metastatic gastric or esophago-gastric cancer to reduce postoperative morbidity (PERCOG): study protocol for a randomized controlled trial

SPIRIT 2013 checklist. (PDF 104 kb

Exploratory subgroup analysis, CWEP vs. control in different degrees of contamination.

<p>A clean surgeries; B clean-contaminated surgeries; C contaminated surgeries; D dirty-infected surgeries.</p

Flow diagram of studies selected according to PRISMA guidelines [34].

<p>Flow diagram of studies selected according to PRISMA guidelines [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121187#pone.0121187.ref034" target="_blank">34</a>].</p

Individual trial data, pooled effect estimates and forest plot of the 16 randomized-controlled trials included in the meta-analysis.

<p>CWEPs vs. control with SSI as outcome parameter (RevMan 5.2 output).</p

Endpoints, surgical site infections and outcomes of included studies. NR: not recorded.

<p>Endpoints, surgical site infections and outcomes of included studies. NR: not recorded.</p

Characteristics of the included studies with description of intervention and control, risk factors for surgical site infections and level of contamination.

<p>NR: not recorded. * unclear whether trial was single center or performed at two trial sites.</p><p>Characteristics of the included studies with description of intervention and control, risk factors for surgical site infections and level of contamination.</p

This figure demonstrates the micrographs (HE, 50×; 70×) of a post-IBT tumor responder with near complete postinterventional tumor necrosis (a), and of a tumor non-responder to IBT with necrotic tumor areas next to pseudoglandular HCC nodules (b), respectively.

<p>This figure demonstrates the micrographs (HE, 50×; 70×) of a post-IBT tumor responder with near complete postinterventional tumor necrosis (a), and of a tumor non-responder to IBT with necrotic tumor areas next to pseudoglandular HCC nodules (b), respectively.</p