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Systematic review and meta-analysis of wound bundles in emergency midline laparotomy identifies that it is time for improvement

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Show simple item record McGeehan, Gearóid Edelduok, Itoro M. Bucholc, Magda Watson, Angus Bodnar, Zsolt Johnston, Alison Sugrue, Michael 2021-03-09T11:33:48Z 2021-03-09T11:33:48Z 2021
dc.description peer-reviewed en_US
dc.description.abstract 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. en_US
dc.language.iso eng en_US
dc.publisher MDPI en_US
dc.relation.ispartofseries Life;11, 138
dc.subject emergency surgery en_US
dc.subject laparotomy en_US
dc.title Systematic review and meta-analysis of wound bundles in emergency midline laparotomy identifies that it is time for improvement en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.3390/life1102013
dc.contributor.sponsor Donegal Clinical and Research Academy en_US
dc.contributor.sponsor European Union (EU) en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US

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