Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

Background: Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. Methods: An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included “emergency surgery”, “laparotomy”, “surgical site infection”, “midline incision” and “wound bundle”. Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. Results: This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39–1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57–1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. Conclusions: This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle’s ability to potentially improve outcome after emergency laparotomy.

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P107 PREVENTION OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY WITH MODIFICATION OF CLOSURE TECHNIQUE: SYSTEMATIC REVIEW AND META ANALYSIS

British Journal of Surgery ◽

10.1093/bjs/znab395.100 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Edgard Efren Lozada Hernandez ◽

Juan Pablo Hernandez Bonilla ◽

Enrique Obregon Moreno ◽

Diego Hinojosa Ugarte ◽

Aldo Jimenez Herevia ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Incisional Hernia ◽

Surgical Site Infection ◽

Meta Analysis ◽

Wound Dehiscence ◽

Site Infection ◽

Closure Technique ◽

Midline Laparotomy ◽

Significant Difference

Abstract Aim “Incisional hernia is the main complication after laparotomy, the prevention of this is currently aimed at preoperative rehabilitation, modification of the closure technique and the use of prophylactic mesh. The objective of the study was to measure the effectiveness of the modification in the laparotomy closure technique to reduce the incidence of incisional hernia.” Material and Methods “A systematic review and meta-analysis were carried out following the PRISMA guidelines. The first objective was to determine the incidence of incisional hernia at one year of follow-up, comparing the modification in the closure technique with the usual closure. The secondary objective was to determine the difference in wound dehiscence and surgical site infection between these two groups. Only clinical trials were included, and the random effects method was used for their analysis. PROSPERO registration number: CRD42021231107” Results “Seven clinical trials were included, comparing 1612 patients, the incidence of incisional hernia was significantly lower in the surgical technique modification group OR 0.55 (95% CI 0.38-79). Efficacy to reduce the incidence of wound dehiscence was also analyzed without finding a difference between the two groups OR 0.58 (95% CI 0.27-1.21). There was no statistically significant difference between both groups when comparing seroma hematoma and surgical site infection.” Conclusions “The modification in the laparotomy closure technique reduces the incidence of incisional hernia. However, when analyzing globally, only the Small bites and Reinforced tension line techniques contributed to this result.”

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PREVENTION OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY WITH MODIFICATION OF CLOSURE TECHNIQUE: SYSTEMATIC REVIEW AND META ANALYSIS

British Journal of Surgery ◽

10.1093/bjs/znab160.019 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

E E Lozada Hernández ◽

J P Hernández Bonilla ◽

D Hinojosa Ugarte

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Incisional Hernia ◽

Surgical Site Infection ◽

Meta Analysis ◽

Wound Dehiscence ◽

Site Infection ◽

Closure Technique ◽

Midline Laparotomy ◽

Significant Difference

Abstract INTRODUCTION Incisional hernia is the main complication after laparotomy, the prevention of this is currently aimed at preoperative rehabilitation, modification of the closure technique and the use of prophylactic mesh. The objective of the study was to measure the effectiveness of the modification in the laparotomy closure technique to reduce the incidence of incisional hernia. MATERIAL AND METHODS. A systematic review and meta-analysis were carried out following the PRISMA guidelines. The first objective was to determine the incidence of incisional hernia at one year of follow-up, comparing the modification in the closure technique with the usual closure. The secondary objective was to determine the difference in wound dehiscence and surgical site infection between these two groups. Only clinical trials were included and the random effects method was used for their analysis. RESULTS Seven clinical trials were included, comparing 1612 patients, the incidence of incisional hernia was significantly lower in the surgical technique modification group OR 0.55 (95% CI 0.38-79). Efficacy to reduce the incidence of wound dehiscence was also analyzed without finding a difference between the two groups OR 0.58 (95% CI 0.27-1.21). There was no statistically significant difference between both groups when comparing seroma hematoma and surgical site infection. CONCLUSIONS The modification in the laparotomy closure technique reduces the incidence of incisional hernia. However, when analyzing globally, only the Small bites and Reinforced tension line techniques contributed to this result.

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