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Groenen H, Bontekoning N, Jalalzadeh H, Buis DR, Dreissen YEM, Goosen JHM, Graveland H, Griekspoor M, IJpma FFA, van der Laan MJ, Schaad RR, Segers P, van der Zwet WC, Orsini RG, Eskes AM, Wolfhagen N, de Jonge SW, Boermeester MA. Incisional Wound Irrigation for the Prevention of Surgical Site Infection: A Systematic Review and Network Meta-Analysis. JAMA Surg 2024; 159:792-800. [PMID: 38656408 PMCID: PMC11044014 DOI: 10.1001/jamasurg.2024.0775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/06/2024] [Indexed: 04/26/2024]
Abstract
Importance Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use. Objective To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery. Data Sources PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023. Study Selection Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded. Data Extraction and Synthesis This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported. Main Outcome and Measure The primary study outcome was SSI. Results A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty). Conclusions and Relevance This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.
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Affiliation(s)
- Hannah Groenen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Nathan Bontekoning
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Hasti Jalalzadeh
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Dennis R. Buis
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Yasmine E. M. Dreissen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Jon H. M. Goosen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, the Netherlands
| | - Haitske Graveland
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Mitchel Griekspoor
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Dutch Association of Medical Specialists, Utrecht, the Netherlands
| | - Frank F. A. IJpma
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Maarten J. van der Laan
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Roald R. Schaad
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, the Netherlands
- Dutch Association of Anaesthesiology (NVA), the Netherlands
| | - Patrique Segers
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Wil C. van der Zwet
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ricardo G. Orsini
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Anne M. Eskes
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Niels Wolfhagen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
| | - Stijn W. de Jonge
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands
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Campbell DH, Dowling TJ, Hah R, Alluri RK, Wang JC. Surgical strategies for spinal infections: A narrative review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100293. [PMID: 38162170 PMCID: PMC10757275 DOI: 10.1016/j.xnsj.2023.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
The successful operative management of spinal infections necessitates a thoughtful approach. Ideal treatment combines the universal goals of any spine operation, which are decompression of the neural elements and stabilization of instability, with source control and eradication of infection. Techniques to treat infection have evolved independently and alongside advances in implant technology and surgical techniques. This review will seek to outline current thinking on approaches to both primary and secondary spinal infections.
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Affiliation(s)
- David H. Campbell
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - Thomas J. Dowling
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - R. Kiran Alluri
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - Jeffrey C. Wang
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
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Luo J, Yang J, Peng M, Liu F, Zhou X, Yin H, Li J. Efficacy and safety of Chinese herbal medicine Wuwei Xiaodu Drink for wound infection: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32135. [PMID: 36482518 PMCID: PMC9726315 DOI: 10.1097/md.0000000000032135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Wound infection (WI) is a disease in which pathogenic bacteria invade and multiply in a wound after trauma or surgery, causing a systemic inflammatory response. WI triggers an immune response in the body, resulting in inflammation and tissue damage, as well as slowing down the healing process. The traditional Chinese medicine prescription of Wuwei Xiaodu Drink (WWXDD) has been widely used in clinical practice with good results. However, there is no high-level evidence to support this result. The purpose of this study was to evaluate the efficacy and safety of WWXDD in the treatment of WI. METHODS We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), Chinese databases SinoMed (CBM), PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction on language and status, the time from the establishment of the database to October 2022. Two reviewers will independently assess the quality of the selected studies, NoteExpress and Excel software will be used to extract data, and the content will be stored in an electronic chart. Different researchers will separately screen the titles and abstracts of records acquired potential eligibility which comes from the electronic databases. Full-text screening and data extraction will be conducted afterward independently. Statistical analysis will be conducted using RevMan 5.4 software (Cochrane Collaboration). RESULTS What this study will do is evaluate the efficacy and safety of WWXDD in the treatment of WI in order to provide high quality, evidence-based clinical recommendations. CONCLUSION This research provides a trusted clinical foundation for the treatment of WI with WWXDD.
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Affiliation(s)
- Jie Luo
- Taizhou Traditional Chinese Medicine Hospital, Taizhou City, Zhejiang Province, China
| | - Jingfan Yang
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Ming Peng
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Fang Liu
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Xing Zhou
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang, China
| | - Hong Yin
- Kunming University of Science and Technology Hospital, Kunming City, Yunnan Province, China
- * Correspondence: Jinlei Li, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, No. 25, Dongfeng East Road, Panlong District, Kunming City, Yunnan Province, P.R. China (e-mail: ) and Hong Yin, Kunming University of Science and Technology Hospital, Kunming, No. 727, Jingming South Road, Chenggong District, Kunming City, Yunnan Province, P.R. China (e-mail: )
| | - Jinlei Li
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
- * Correspondence: Jinlei Li, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, No. 25, Dongfeng East Road, Panlong District, Kunming City, Yunnan Province, P.R. China (e-mail: ) and Hong Yin, Kunming University of Science and Technology Hospital, Kunming, No. 727, Jingming South Road, Chenggong District, Kunming City, Yunnan Province, P.R. China (e-mail: )
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Wan J, He J, Chen L, Qiu L, Wang F, Chen XL. Retrospective Study from a Single Center on the Efficacy of Pulsed Lavage Following Excision of Burns ≥30% of the Total Body Surface Area in 63 Patients. Med Sci Monit 2022; 28:e937697. [PMID: 36348616 PMCID: PMC9661869 DOI: 10.12659/msm.937697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Ensuring the take rate of skin grafting and reducing the mortality of patients with severe burns have remained big challenges worldwide. This retrospective study from a single center aimed to evaluate the efficacy of pulsed lavage following excision of burns ≥30% of the total body surface area (TBSA) in 63 patients. MATERIAL AND METHODS Among 63 patients, the types of burns sustained were severe burns and extremely severe burns (≥30% TBSA). The degrees of the burns were second degree and third degree, and the causes were thermal, chemical, and electric. Patients with early aggressive excision were divided into a pulsed lavage group and control group. The constituent of the lavage fluid was 0.9% physiological saline. The evaluation of wound healing and complications was based on the wound healing rate and time, clinical symptoms, and examination. We determined the take rate of skin grafting, positive rate of postoperative bacterial cultures, changes in perioperative serum C-reactive protein (CRP) and procalcitonin (PCT) levels, and incidence of secondary grafting. RESULTS The take rate of skin grafting and the decreased rates of perioperative serum CRP and PCT levels were significantly higher in the pulsed lavage group than in the control group (P<0.05). Moreover, the positive rate of wound postoperative bacterial cultures and mortality in the pulsed lavage group showed remarkably lower levels (P<0.05). CONCLUSIONS Pulsed lavage following excision of burns ≥30% TBSA increased the take rate of skin grafting, alleviated the positive rate of postoperative bacterial cultures, decreased serum CRP and PCT levels, and reduced mortality.
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Affiliation(s)
- Jia Wan
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Jia He
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Lu Chen
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Le Qiu
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Fei Wang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Xu-Lin Chen
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
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Luck T, Zaki P, Michels R, Slotkin EM. The Cost-Effectiveness of Normal-Saline Pulsed Lavage for Infection Prophylaxis in Total Joint Arthroplasty. Arthroplast Today 2022; 18:107-111. [PMID: 36304695 PMCID: PMC9593269 DOI: 10.1016/j.artd.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Prosthetic joint infection (PJI) is a well-described complication after total joint arthroplasty which imposes a substantial burden of morbidity and mortality on the individual, as well as cost to the health-care system. This study used a break-even analysis to investigate the cost-effectiveness of pulsed saline lavage (PSL) for PJI prophylaxis after a primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods An established model was used to calculate the minimum cost-effective absolute risk reduction of PSL for infection prophylaxis after a total joint arthroplasty. Baseline infection rates of TKA and THA and the cost of a revision surgery for PJI were derived from the literature while the cost of PSL implementation was obtained from institutional data. Results PSL is cost-effective at an initial infection rate of 1.10%, revision costs of $32,132 for TKA PJI, and a protocol cost of $38.28 if it reduces infection rates by 0.12% or prevents infection in 1 out of 839 patients. PSL is cost-effective at an initial infection rate of 1.63% and a revision cost of $39,713 for THA PJI if it reduces infection rates by 0.10% or prevents infection in 1 out of 1037 patients. The absolute risk reduction needed for economic viability did not change with varying baseline infection rates and did not exceed 0.38% for infection treatment costs as low as $10,000 and remained less than 0.47% even if PSL cost was as high as $150. Conclusions The use of PSL is a cost-effective protocol for PJI prophylaxis after TKAs and THAs.
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Affiliation(s)
- Trevor Luck
- Drexel University College of Medicine, Philadelphia, Pennsylvania,Corresponding author. Drexel University College of Medicine, 613 Sandstone Drive, Wyomissing, PA 19610, USA. Tel.: +1 207 590 8513.
| | - Peter Zaki
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ryan Michels
- Reading Hospital, Orthopaedic Associates of Reading, Wyomissing, Pennsylvania
| | - Eric M. Slotkin
- Reading Hospital, Orthopaedic Associates of Reading, Wyomissing, Pennsylvania
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Torres KA, Konrade E, White J, Tavares Junior MCM, Bunch JT, Burton D, Jackson RS, Birlingmair J, Carlson BB. Irrigation techniques used in spine surgery for surgical site infection prophylaxis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2022; 23:813. [PMID: 36008858 PMCID: PMC9414142 DOI: 10.1186/s12891-022-05763-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background The greater likelihood of morbidity, mortality, length of hospital stays and poorer long-term outcomes as a result of surgical site infections secondary to spinal surgery makes prophylactic measures an imperative focus. Therefore, the aim of this review was to evaluate the available research related to the efficacy of different intraoperative irrigation techniques used in spinal surgery for surgical site infection (SSI) prophylaxis. Methods We performed a comprehensive search using Ovid Medline, EMBASE, Web of Science and the Cochrane library pertaining to this topic. Our meta-analysis was conducted according to PRISMA guidelines. The inclusion criteria consist of spine surgeries with intraoperative use of any wound irrigation technique, comparison groups with a different intraoperative irrigation technique or no irrigation, SSI identified with bacterial cultures or clinically in the postoperative period, reported SSI rates. Data extracted from eligible studies included, but was not limited to, SSI rates, irrigation technique and control technique. Exclusion criteria consist of articles with no human subjects, reviews, meta-analyses and case control studies and no details about SSI identification or rates. Pooled risk ratios were calculated. A meta-analysis was performed with a forest plot to determine risk estimates’ heterogeneity with I2 index, Q-statistic, and p value under a random-effects model. Funnel plot was used to assess publication bias. All databases were last checked on January, 2022. PROBAST tool was used to assess both risk of bias and applicability concerns. Results After reviewing 1494 titles and abstracts, 18 articles met inclusion criteria. They included three prospective randomized-controlled trials, 13 retrospective cohort studies, two prospective cohort studies. There were 54 (1.8%) cases of SSIs in the povidone-iodine irrigation group (N = 2944) compared to 159 (4.6%) in the control group (N = 3408). Using intraoperative povidone-iodine wound irrigation produced an absolute risk reduction of 2.8%. Overall risk ratio was 0.32 (95% CI 0.20–0.53, p < 0.00001). In a global analysis, study heterogeneity and synthesizing mostly retrospective data were primary limitations. Conclusion The most evidence exists for povidone-iodine and has Level 2 evidence supporting SSI reduction during spinal surgery. Other antiseptic solutions such as dilute chlorhexidine lack published evidence in this patient population which limits the ability to draw conclusions related to its use in spinal surgery. Level of Evidence II – Systematic Review with Meta-Analysis.
Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05763-2.
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Affiliation(s)
- Kabir A Torres
- Department of Surgery, The University of Missouri - Kansas City School of Medicine, 2301 Holmes Street, MO, 64108, Kansas City, USA
| | - Elliot Konrade
- School of Medicine, The University of Kansas, Kansas City, USA
| | - Jacob White
- Welch Medical Library, Johns Hopkins University, Baltimore, USA
| | - Mauro Costa M Tavares Junior
- Department of Orthopedic Surgery, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS, Zip code: 66160, USA
| | - Joshua T Bunch
- Department of Orthopedic Surgery, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS, Zip code: 66160, USA
| | - Douglas Burton
- Department of Orthopedic Surgery, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS, Zip code: 66160, USA
| | - R Sean Jackson
- Department of Orthopedic Surgery, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS, Zip code: 66160, USA
| | - Jacob Birlingmair
- Department of Orthopedic Surgery, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS, Zip code: 66160, USA
| | - Brandon B Carlson
- Department of Orthopedic Surgery, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS, Zip code: 66160, USA.
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Duquette E, Bhatti P, Sur S, Felbaum DR, Dowlati E. The History and Use of Antibiotic Irrigation for Preventing Surgical Site Infection in Neurosurgery: A Scoping Review. World Neurosurg 2022; 160:76-83. [DOI: 10.1016/j.wneu.2022.01.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 11/28/2022]
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Bath MF, Suresh R, Davies J, Machesney MR. Does pulsed lavage reduce the risk of surgical site infection? A systematic review and meta-analysis. J Hosp Infect 2021; 118:32-39. [PMID: 34454976 DOI: 10.1016/j.jhin.2021.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) remain a significant and common postoperative complication. Whereas most surgeons use some form of wound irrigation during closure, its impact on SSI rates is debated. Preliminary studies in the use of pressurized irrigation, termed pulsed lavage, may have potential benefit to reduce the risk of SSI. AIM To perform a systematic review to identify studies that reported SSI rates following surgery, comparing the use of pulsed lavage to controls, following PRISMA guidelines. METHODS All study types and those published up to January 1st, 2021 were included. Odds ratios (ORs) were calculated for each included study using a Mantel-Haenszel statistical analysis, via a random effects model. A sub-analysis on abdominal procedures only was also performed. FINDINGS Eleven studies met the inclusion criteria, covering either orthopaedic or general surgery procedures; 1875 patients were included, with 816 patients in the pulsed lavage group and 1059 patients in the control group. Overall study quality was low. There was a significant reduction in the SSI rate with the use of pulsed lavage (odds ratio (OR): 0.39; 95% confidence interval (CI): 0.25-0.62; P < 0.0001). Sub-analysis on abdominal operations only showed further improvement to the SSI rate with pulsed lavage (OR: 0.32; 95% CI: 0.21-0.49; P < 0.0001). CONCLUSION Pulsed lavage significantly reduces the rate of SSIs in surgical procedures, the effect being most pronounced in abdominal operations; however, current study quality is low. Randomized controlled trial data are essential to fully assess the potential clinical and financial benefits pulsed lavage can confer to SSI reduction.
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Affiliation(s)
- M F Bath
- Department of Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
| | - R Suresh
- Department of Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - J Davies
- Department of Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - M R Machesney
- Department of Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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Zhao J, Zhang S, Li X, He B, Ou Y, Jiang D. Comparison of Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Lumbar Disc Herniation: A Retrospective Cohort Study. Med Sci Monit 2018; 24:8693-8698. [PMID: 30504756 PMCID: PMC6286631 DOI: 10.12659/msm.912808] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background This cohort study compared the efficacy and safety of minimally invasive versus open transforaminal lumbar interbody fusion (Mis-TLIF versus Open-TLIF) for lumbar disc herniation with radiculopathy. Material/Methods From July 2016 to September 2017, we recruited 37 patients suffering from lumbar disc herniation with radiculopathy. Seventeen patients underwent Mis-TLIF (Mis group) and 20 patients underwent Open-TLIF (Open group). Baseline characteristics were similar between the 2 groups before surgery. We compared postoperative clinical and radiological outcomes between the 2 groups. Results Compared to patients in the Open group, patients in the Mis group has significantly less intraoperative hemorrhage, drainage fluid, time to go, and hospital stay after surgery, but had longer operation times (P<0.05). These 2 groups had similar postoperative hemoglobin reduction and drain removal time. In addition, the postoperative back and leg pain and intervertebral height reduction at 3 months after surgery in the Mis group were remarkably lower than those in the Open group. There was no significant difference in postoperative Oswestry disability index (ODI) or intervertebral height change immediately after surgery and at 1 month postoperatively between the 2 groups. Conclusions Mis-TLIF shows some benefits in lumbar disc herniation compared to Open-TLIF in terms of intraoperative hemorrhage, drainage fluid, time to go, hospital stay after surgery, and postoperative back and leg pain.
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Affiliation(s)
- Jinqiu Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Shujun Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Xiaosong Li
- Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Bin He
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Yunsheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Dianming Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
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Chen YC, Zhang L, Li EN, Ding LX, Zhang GA, Hou Y, Yuan W. One or Two Drains for the Treatment of Surgical Site Infections After Lumbar Spine Surgery. World Neurosurg 2018; 116:e18-e25. [DOI: 10.1016/j.wneu.2018.02.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 12/09/2022]
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