Systematic review and meta-analysis of randomized controlled trials I of the clinical effectiveness of impervious plastic wound protectors in reducing surgical site infections in patients undergoing abdominal surgery

Background: Surgical site infections are a common postoperative complication after abdominal surgery. Although impervious plastic wound protectors have been used in surgery to reduce surgical site infection rates, the effectiveness of impervious plastic wound protectors for reduction of surgical site infections remains unclear. This study aimed to determine the clinical effectiveness of impervious plastic wound protectors in reducing surgical site infection rates after abdominal surgery. Methods: A systematic review of the PubMed, Embase, and Cochrane Library databases was performed to identify randomized clinical trials evaluating surgical site infection risk after abdominal surgeries with and without the use of impervious ilastic wound protectors. The outcome of interest was a well specified, clinically based definition of surgical site infections. No language or time restrictions were applied. The pooled risk ratio was estimated with random-effect meta-analysis. The quality assessment of the studies and the quantitative analyses were performed in line with the principles of the Cochrane Collaboration. Results: Of the 400 studies identified, 14 randomized controlled trials representing 2,684 patients were included in this review. The pooled risk ratio under a random-effects model was 0.70 (95% confidence interval, 0.51-0.96; I-2, 56.8%), indicating a potentially significant benefit from impervious plastic wound protector use. There was a significant trend toward greater protective effect in studies using a dual ring protector (relative risk = 0.31; 95% confidence interval, 0.15-0.58), rather than a single ring protector (relative risk = 0.84; 95% confidence interval, 0.71-1.00). There was no significant between-study heterogeneity or publication bias. Conclusion: This study suggests that impervious plastic wound protectors are efficient in reducing surgical site infection rates in patients undergoing abdominal surgery. (C) 2018 Elsevier Inc. All rights reserved.