Kai Pang1, Peilin Sun2, Jun Li1, Na Zeng3, Xiaobao Yang1, Lei Jin1, Yingchi Yang4, Lan Jin5, Hongwei Yao1, Zhongtao Zhang6. 1. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China. 2. Peking Union Medical College, PUMC, Beijing, 100730, China. 3. Department of Methodology and Statistics, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing, 100050, China. 4. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China. yangyingchi@ccmu.edu.cn. 5. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China. jinlan@ccmu.edu.cn. 6. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China. zhangzht@ccmu.edu.cn.
Abstract
BACKGROUND: Due to lack of high-level evidences, prophylactic subcutaneous drainage has so far not been recommended in relevant guidelines as a countermeasure against incisional infections. This meta-analysis aims to clarify the efficacy of subcutaneous drainage in reducing incisional infections in colorectal surgeries. METHODS: Cochrane Library, Embase, and PubMed were searched for randomized controlled trials comparing the incidence rate of incisional infections between patients receiving prophylactic subcutaneous drainage (interventions) and those not receiving (controls) after digestive surgeries. Results from included RCTs were pooled multiple times according to different surgical types. Heterogeneity, publication bias, and certainty of evidences were estimated. RESULTS: Eight randomized controlled trials were included. Three RCTs each included patients receiving all sorts of digestive surgeries (gastrointestinal, hepatobiliary, and pancreatic); pooled incisional infection rates between the drainage group and the control group were not significantly different (RR = 0.76, 95%CI: 0.48-1.21, p = 0.25). Four RCTs included patients receiving colorectal surgeries; pooled incisional infection rate in the drainage group was significantly lower than that in the control group (RR = 0.34, 95%CI: 0.19-0.61, p = 0.0004). Four RCTs included patients receiving upper GI and/or HBP surgeries; pooled incisional infection rates in the drainage group and the non-drainage group were not significantly different (RR = 0.85, 95%CI: 0.54-1.34, p = 0.49). CONCLUSIONS: Prophylactic subcutaneous drainage significantly reduces post-operative incisional infections in colorectal surgeries but was not efficacious in digestive surgeries in general.
BACKGROUND: Due to lack of high-level evidences, prophylactic subcutaneous drainage has so far not been recommended in relevant guidelines as a countermeasure against incisional infections. This meta-analysis aims to clarify the efficacy of subcutaneous drainage in reducing incisional infections in colorectal surgeries. METHODS: Cochrane Library, Embase, and PubMed were searched for randomized controlled trials comparing the incidence rate of incisional infections between patients receiving prophylactic subcutaneous drainage (interventions) and those not receiving (controls) after digestive surgeries. Results from included RCTs were pooled multiple times according to different surgical types. Heterogeneity, publication bias, and certainty of evidences were estimated. RESULTS: Eight randomized controlled trials were included. Three RCTs each included patients receiving all sorts of digestive surgeries (gastrointestinal, hepatobiliary, and pancreatic); pooled incisional infection rates between the drainage group and the control group were not significantly different (RR = 0.76, 95%CI: 0.48-1.21, p = 0.25). Four RCTs included patients receiving colorectal surgeries; pooled incisional infection rate in the drainage group was significantly lower than that in the control group (RR = 0.34, 95%CI: 0.19-0.61, p = 0.0004). Four RCTs included patients receiving upper GI and/or HBP surgeries; pooled incisional infection rates in the drainage group and the non-drainage group were not significantly different (RR = 0.85, 95%CI: 0.54-1.34, p = 0.49). CONCLUSIONS: Prophylactic subcutaneous drainage significantly reduces post-operative incisional infections in colorectal surgeries but was not efficacious in digestive surgeries in general.
Authors: Kristen A Ban; Joseph P Minei; Christine Laronga; Brian G Harbrecht; Eric H Jensen; Donald E Fry; Kamal M F Itani; E Patchen Dellinger; Clifford Y Ko; Therese M Duane Journal: J Am Coll Surg Date: 2016-11-30 Impact factor: 6.113
Authors: Benedetta Allegranzi; Bassim Zayed; Peter Bischoff; N Zeynep Kubilay; Stijn de Jonge; Fleur de Vries; Stacey M Gomes; Sarah Gans; Elon D Wallert; Xiuwen Wu; Mohamed Abbas; Marja A Boermeester; E Patchen Dellinger; Matthias Egger; Petra Gastmeier; Xavier Guirao; Jianan Ren; Didier Pittet; Joseph S Solomkin Journal: Lancet Infect Dis Date: 2016-11-02 Impact factor: 25.071
Authors: Benedetta Allegranzi; Peter Bischoff; Stijn de Jonge; N Zeynep Kubilay; Bassim Zayed; Stacey M Gomes; Mohamed Abbas; Jasper J Atema; Sarah Gans; Miranda van Rijen; Marja A Boermeester; Matthias Egger; Jan Kluytmans; Didier Pittet; Joseph S Solomkin Journal: Lancet Infect Dis Date: 2016-11-02 Impact factor: 25.071
Authors: J C Lauscher; V Schneider; L D Lee; A Stroux; H J Buhr; M E Kreis; J P Ritz Journal: Langenbecks Arch Surg Date: 2016-05-01 Impact factor: 3.445
Authors: Sandra I Berríos-Torres; Craig A Umscheid; Dale W Bratzler; Brian Leas; Erin C Stone; Rachel R Kelz; Caroline E Reinke; Sherry Morgan; Joseph S Solomkin; John E Mazuski; E Patchen Dellinger; Kamal M F Itani; Elie F Berbari; John Segreti; Javad Parvizi; Joan Blanchard; George Allen; Jan A J W Kluytmans; Rodney Donlan; William P Schecter Journal: JAMA Surg Date: 2017-08-01 Impact factor: 14.766