Work

Intraoperative wound irrigation for surgical site infection prevention after laparotomy - A systematic review and network meta-analysis of randomised clinical trials

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: 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 2943 patients. Overall, 1292 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.

Source: The American Journal of Surgery

DOI: 10.1016/j.amjsurg.2026.116930

Authors: Matthew G. Davey, Czara A. Kennedy, Mohammed Alazzawi, Conor Toale, Carolyn Cullinane, Noel E. Donlon

Institutions: Royal College of Surgeons in Ireland, St. James's Hospital

Language: English

Topic: Surgical site infection prevention

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,830