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Editor's Choice – Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery
- Source :
- European Journal of Vascular and Endovascular Surgery. 61:636-646
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Groin incision surgical site infections (SSIs) following arterial surgery are common and are a source of considerable morbidity. This review evaluates interventions and adjuncts delivered immediately before, during, or after skin closure, to prevent SSIs in patients undergoing arterial interventions involving a groin incision.MEDLINE, EMBASE, and CENTRAL databases were searched.This review was undertaken according to established international reporting guidelines and was registered prospectively with the International prospective register of systematic reviews (CRD42020185170). The MEDLINE, EMBASE, and CENTRAL databases were searched using pre-defined search terms without date restriction. Randomised controlled trials (RCTs) and observational studies recruiting patients with non-infected groin incisions for arterial exposure were included; SSI rates and other outcomes were captured. Interventions reported in two or more studies were subjected to meta-analysis.The search identified 1 532 articles. Seventeen RCTs and seven observational studies, reporting on 3 747 patients undergoing 4 130 groin incisions were included. A total of seven interventions and nine outcomes were reported upon. Prophylactic closed incision negative pressure wound therapy (ciNPWT) reduced groin SSIs compared with standard dressings (odds ratio [OR] 0.34, 95% CI 0.23 - 0.51; p.001, GRADE strength of evidence: moderate). Local antibiotics did not reduce groin SSIs (OR 0.60 95% CI 0.30 - 1.21 p = .15, GRADE strength: low). Subcuticular sutures (vs. transdermal sutures or clips) reduced groin SSI rates (OR 0.33, 95% CI 0.17 - 0.65, p = .001, GRADE strength: low). Wound drains, platelet rich plasma, fibrin glue, and silver alginate dressings did not show any significant effect on SSI rates.There is evidence that ciNPWT and subcuticular sutures reduce groin SSI in patients undergoing arterial vascular interventions involving a groin incision. Local antibiotics did not reduce groin wound SSI, although the strength of this evidence is lower. No other interventions demonstrated a significant effect.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
MEDLINE
Psychological intervention
030204 cardiovascular system & hematology
030230 surgery
Groin
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Risk Factors
Negative-pressure wound therapy
medicine
Humans
Surgical Wound Infection
Randomized Controlled Trials as Topic
business.industry
Suture Techniques
Arteries
Odds ratio
Anti-Bacterial Agents
Surgery
Observational Studies as Topic
Treatment Outcome
Systematic review
medicine.anatomical_structure
Meta-analysis
Observational study
Cardiology and Cardiovascular Medicine
business
Vascular Surgical Procedures
Negative-Pressure Wound Therapy
Subjects
Details
- ISSN :
- 10785884
- Volume :
- 61
- Database :
- OpenAIRE
- Journal :
- European Journal of Vascular and Endovascular Surgery
- Accession number :
- edsair.doi.dedup.....025180bcb61cb664ca80365146841780