Intraoperative Wound Irrigation for Surgical Site Infection Prevention after Laparotomy - A Systematic Review and Network Meta-Analysis of Randomised Clinical Trials

Introduction: There are conflicting recommendations surrounding the use of intraoperative wound irrigation (IOWI) to reduce surgical site infections (SSIs) for patients undergoing laparotomy.This study aimed to perform a systematic review and network meta-analysis of randomised clinical trials (RCTs) to elucidate the most appropriate IOWI solution to reduce SSIs following laparotomy.Methods: A systematic review and network meta-analysis (NMA) was performed as per preferred reporting items for systematic reviews and meta-analysis (PRISMA)-NMA extension.Data analytics were performed using shiny and R.Results: 11 RCTs were included involving 2,943 patients.Overall, 1,292 patients were randomised to normal saline (NS) (43.9%), 771 to povidone iodine (PI) (26.2%), 519 to polyhexidine (PH) (17.6%), 180 to electrolysed strongly acidic aqueous solution (ESAAS) (6.1%), 102 to none (control) (3.5%) and 79 to olanexidine (O) (2.7%).Non-significant differences in patient age, gender, body mass indices, or American Society of Anaesthesiologist grade were observed for each IOWI group (all P>0.050).At NMA, IOWI using PH significantly reduced all cause SSIs in patients undergoing laparotomy (odds ratio (OR): 0.54, 95% confidence interval (CI): 0.36 -0.80).Furthermore, IOWI using PH (OR: 0.54, 95% CI: 0.36 -0.80) and ESAAS (OR: 0.36, 95% CI: 0.13 -0.98) significantly reduced superficial SSI (SSSI) in patients undergoing laparotomy.For patients undergoing laparotomy in the elective setting, PH significantly reduced both SSI (OR: 0.41, 95% CI: 0.25 -0.68) and SSSI (OR: 0.42, 95% CI: 0.22 -0.82) rates. Conclusion:IOWI with PH reduces SSIs in patients undergoing laparotomy and should therefore be considered in patients undergoing this procedure.