The effect of type of ventilation used in the operating room and surgical site infection: A meta-analysis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1316 ◽

2020 ◽

pp. 1-6

Author(s):

Jian Bao ◽

Jianhua Li

Keyword(s):

Vascular Surgery ◽

Surgical Site Infection ◽

Operating Room ◽

Hip Replacement ◽

Meta Analysis ◽

Conventional Ventilation ◽

Total Knee Arthroplasties ◽

Site Infection ◽

Room Ventilation ◽

Total Knee

Abstracts Background: The relation between type of ventilation used in the operating room and surgical site infection has drawn considerable attention with its conflicting results. A possible relationship between the type of ventilation used in the operating room and surgical site infection has been reported. This meta-analysis was performed to evaluate this relationship. Methods: A systematic literature search up to May 2020 identified 14 studies with 590,121 operations, 328,183 operations of which were performed under laminar airflow ventilation and 261,938 of which were performed operations under conventional ventilation. These articles reported relationships between type of operating-room ventilation with its different categories and surgical site infection: 10 studies were related to surgical site infection in the total hip replacement; 7 studies in total knee arthroplasties; and 3 studies in different abdominal and open vascular surgery. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated comparing surgical site infection prevalence and type of operating room ventilation using the dichotomous method with a random-effects or fixed-effects model. Results: No significant difference was found between operation performed under laminar airflow ventilation and conventional ventilation in total hip replacement (OR, 1.23; 95% CI, 0.97–1.56, P = .09), in total knee arthroplasties (OR, 1.14; 95% CI, 0.62–2.09; P = .67), and in different abdominal and open vascular surgery (OR, 0.75; 95% CI, 0.43-1.33; P = .33). The impact of the type of operating room ventilation may have no influence on surgical site infection as a tool for decreasing its occurrence. Conclusions: Based on this meta-analysis, operating under laminar airflow or conventional ventilation may have no independent relationship with the risk of surgical site infection. This relationship forces us not to recommend the use of laminar airflow ventilation because it has a much higher cost compared to conventional ventilation.

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Faculty Opinions recommendation of Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1158112.618216 ◽

2009 ◽

Author(s):

Peter Wilson ◽

Thomas Haustein

Keyword(s):

Abdominal Surgery ◽

Protective Effect ◽

Surgical Site Infection ◽

Operating Room ◽

Infection Rate ◽

Site Infection ◽

Surgical Site Infection Rate ◽

Room Ventilation

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A systematic review and meta-analysis of randomized controlled trials for the reduction of surgical site infection in closed incision management versus standard of care dressings over closed vascular groin incisions

Vascular ◽

10.1177/1708538119890960 ◽

2020 ◽

Vol 28 (3) ◽

pp. 274-284 ◽

Cited By ~ 3

Author(s):

Alexander Gombert ◽

Ellen Dillavou ◽

Ralph D’Agostino ◽

Leah Griffin ◽

Julie M Robertson ◽

...

Keyword(s):

Vascular Surgery ◽

Surgical Site Infection ◽

Meta Analysis ◽

Site Infection ◽

Infection Rates ◽

Control Groups ◽

Randomized Controlled ◽

Risk Patients ◽

Meta Analyses ◽

And Control

Objective Surgical site infection after groin incision is a common complication and a financial burden to patients and healthcare systems. Closed incision negative pressure therapy (ciNPT) has been associated with decreased surgical site infection rates in published literature. This meta-analysis examines the effect of ciNPT (PREVENA™ Incision Management System; KCI, San Antonio, TX) versus traditional postsurgical dressing use in reducing surgical site infection rates over closed groin incisions following vascular surgery. Methods A systematic literature search using PubMed, OVID, EMBASE, and QUOSA was performed on 3 January 2019, by two independent researchers and focused on publications between 1 January 2005 and 31 December 2018. The review conformed to the statement and reporting check list of the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Inclusion criteria included abstract or manuscript written in English, published studies, conference abstracts, randomized controlled trials (RCTs), ciNPT usage over closed groin incisions in vascular surgery, comparison of ciNPT use and traditional dressings, study endpoint/outcome of surgical site infection, and study population of >10. Characteristics of study participants, surgical procedure, type of dressing used, duration of treatment, incidence of surgical site infection, and length of follow-up were extracted. Weighted odds ratios and 95% confidence intervals were calculated to pool study and control groups in each publication for analysis. Treatment effects were combined using Mantel-Haenszel risk ratios, and the Chi-Square test was used to assess heterogeneity. Overall, high-risk patients, normal-risk patients, and Szilagyi I, II, III outcomes were assessed between ciNPT and control groups. The Cochrane Collaboration tool was utilized to assess the risk of bias for all studies included in the analysis. Results A total of 615 articles were identified from the literature search. After removal of excluded studies and duplicates, six RCT studies were available for analysis. In these studies, a total of 362 patients received ciNPT, and 371 patients received traditional dressings (control). Surgical site infection events occurred in 41 ciNPT patients and 107 control patients. The heterogeneity test was nonsignificant ( p > 0.05). The overall RCT meta-analysis showed a highly significant effect in favor of ciNPT (OR = 3.06, 95% CI [2.05, 4.58], p < 0.05). High-risk, normal-risk, Szilagyi I, and Szilagyi II meta-analyses were also statistically significant in favor of ciNPT use ( p < 0.05). The varying RCT inclusion/exclusion criteria, such as differences in procedure types, and patient populations form the major limitations of this study. Conclusions A statistically significant reduction in the incidence of surgical site infection was seen following ciNPT usage in patients undergoing vascular surgery with groin incisions.

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