ImportanceSurgical 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.ObjectiveTo compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.Data SourcesPubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.Study SelectionIncluded 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 SynthesisThis 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 MeasureThe primary study outcome was SSI.ResultsA 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 RelevanceThis 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.

中文翻译：

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切口伤口冲洗预防手术部位感染

重要性手术部位感染 (SSI) 是常见的术后并发症，与显着的发病率、死亡率和费用相关。预防性术中切口伤口冲洗可降低SSI的风险，但冲洗液的类型及其使用存在很大差异。目的比较不同类型切口预防性术中切口伤口冲洗预防SSI的效果。数据来源 PubMed、Embase、CENTRAL 和 CINAHL 数据库检索截至 2023 年 6 月 12 日。研究选择本研究中包括随机临床试验 (RCT)，比较切口预防性术中切口伤口冲洗与不冲洗或比较使用不同冲洗方式的冲洗类型的解决方案，以 SSI 作为报告结果。调查腔内灌洗的研究被排除在外。数据提取和合成本系统评价和网络荟萃分析是根据系统评价和荟萃分析声明的首选报告项目进行报告的。两名评审员独立提取数据，并使用 Cochrane 偏倚风险 2 工具评估各个 RCT 中的偏倚风险，并使用建议分级、评估、开发和评价框架评估证据的确定性。进行了频率论网络荟萃分析，并报告了相应的 95% CI 的相对风险 (RR)。 主要结果和测量 主要研究结果是 SSI。 结果 共鉴定出 1587 篇文章，其中 41 篇 RCT 纳入系统研究审查显示，17 188 名患者报告了 1328 起 SSI，总发生率为 7.7%。与不冲洗相比，抗菌溶液（RR，0.60；95% CI，0.44-0.81；高确定性）和抗生素溶液（RR，0.46；95% CI，0.29-0.73；低确定性）与有益地减少 SSI。与不冲洗相比，盐水冲洗没有显示出统计学上的显着差异（RR，0.83；95% CI，0.63-1.09；中等确定性）。 结论和相关性本系统综述和网络荟萃分析发现了高确定性证据，表明预防性术中切口伤口用消毒液冲洗与 SSI 的减少有关。建议避免使用抗生素伤口冲洗，因为其结果的证据质量较差以及全球抗菌素耐药性问题。