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Article

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

1
Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
2
School of Medicine, University of Limerick, V94T9PX Limerick, Ireland
3
Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
4
Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University (Magee Campus), Northern Ireland BT48 7JL, UK
5
Raigmore Hospital, NHS-Highland, Inverness IV2 3DZ, UK
6
Emergency Surgery Outcome Advancement Project, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
*
Author to whom correspondence should be addressed.
Academic Editors: Giuseppe Ietto and Won Kim
Life 2021, 11(2), 138; https://doi.org/10.3390/life11020138
Received: 31 December 2020 / Revised: 20 January 2021 / Accepted: 7 February 2021 / Published: 11 February 2021
(This article belongs to the Special Issue Trauma and Emergency: Beyond Damage Control Surgery)
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. View Full-Text
Keywords: emergency surgery; laparotomy; surgical site infection; midline incision; wound bundle emergency surgery; laparotomy; surgical site infection; midline incision; wound bundle
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MDPI and ACS Style

Mc Geehan, G.; Edelduok, I.M.; Bucholc, M.; Watson, A.; Bodnar, Z.; Johnston, A.; Sugrue, M. Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement. Life 2021, 11, 138. https://doi.org/10.3390/life11020138

AMA Style

Mc Geehan G, Edelduok IM, Bucholc M, Watson A, Bodnar Z, Johnston A, Sugrue M. Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement. Life. 2021; 11(2):138. https://doi.org/10.3390/life11020138

Chicago/Turabian Style

Mc Geehan, Gearóid, Itoro M. Edelduok, Magda Bucholc, Angus Watson, Zsolt Bodnar, Alison Johnston, and Michael Sugrue. 2021. "Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement" Life 11, no. 2: 138. https://doi.org/10.3390/life11020138

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