Intravenous cephalosporin versus non-cephalosporin-based prophylaxis to prevent surgical site infections in colorectal surgery patients: A systematic review and meta-analysis

Figures

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  Fig. 1. PRISMA diagram of studies included in this systematic review and meta-analysis.

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  Fig. 2. Meta-analysis of the odds ratio comparing AP to CBP for clean or clean-contaminated elective colorectal surgery prophylaxis for SSI risk at 30 days. Our primary meta-analysis found no difference in the 30-day SSI risk between the AP and CBP groups (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.91, 1.13; where OR < 1 favors AP.

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  Fig. 3. Fig. a (left). Cumulative meta-analysis of effect size by study quality demonstrated a statistically non-significant trend associating higher study quality with greater effect size, as demonstrated by odds ratios further from the null. Figure 3b (right). Cumulative meta-analysis of effect size by study publication year demonstrated a statistically non-significant trend associating later study publication with smaller effect size.

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  Fig. 4. Fig. 4a (left) Subgroup analysis of effect size by study quality showed significant heterogeneity of effect size within the higher-quality group (I2 = 80%, P=0.02) and the lower-quality group (I2 = 99%, P<0.001) but no difference in subgroup means between the higher- and lower-quality groups. 4b (right) Subgroup analysis of effect size by publication year approached a significant difference in effect size between studies published prior to 2014 and those published in 2014 and later (I2 = 99%, P = 0.06).

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  Fig. 5. Subgroup analysis of effect size by alternative antimicrobial prophylaxis type: carbapenem versus other alternative prophylaxis demonstrated non-significant within-group and between group heterogeneity of effect size.

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  Fig. 6. Bubble-plot showing metaregression on study quality did not demonstrate a significant trend towards higher-quality studies having a larger effect size

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  Fig. 7. Funnel plot bias analysis did not show significant evidence of a missing study effect with Egger test P-value 1.0.