Systematic review and meta-analysis of wound adjuncts for the prevention of groin wound surgical site infection in arterial surgery

Brenig Llwyd Gwilym*, George Dovell, Nikesh Dattani, Graeme K Ambler, Joseph Shalhoub, Forsythe Rachael, Ruth A Benson, Sandip Nandhra, Ryan Preece, Sarah Onida, Louise Hitchman, Patrick A Coughlin, Athanasios Saratzis, David C Bosanquet

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Objective
Groin incision surgical site infections (SSI) 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.DesignSystematic review and meta-analysis.
MethodsThis review was undertaken according to established international reporting guidelines and was prospectively registered 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 subject to meta-analysis.
Results
The search identified 1,532 articles. 17 RCTs and 7 observational studies, reporting on 3,747 patients undergoing 4,130 groin incisions were included. A total of 7 interventions and 9 outcomes, were reported upon. Prophylactic closed incision Negative Pressure Wound Therapy (ciNPWT) reduced groin SSIs compared to standard dressings (Odds Ratio (OR) 0.34, 95% CI 0.23-0.51; p<0.00001, GRADE strength of evidence: moderate). Local antibiotics did not reduce groin SSIs (OR 0.60 95% CI 0.30-1.21 p=0.15, GRADE strength: low). Subcuticular sutures (vs. transdermal sutures or clips) reduced groin SSI rates (OR = 0.33, 95% CI = 0.17 - 0.65, p = 0.001, GRADE strength: low). Wound drains, platelet rich plasma, fibrin glue, and silver alginate dressings did not show any significant effect on SSI rates.
Conclusions
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.
Original languageEnglish
JournalEuropean Journal of Vascular and Endovascular Surgery
Publication statusAccepted/In press - 16 Nov 2020

Keywords

  • Vascular
  • groin incisions
  • surgical site infection

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