Wound protection devices could significantly decrease the risk of surgical site infections after lower gastrointestinal surgery, particularly dual-ring devices, new research suggests.

A meta-analysis of 12 randomized, controlled trials with 3,029 participants found that the use of wound protectors during surgery was associated with 34% lower odds of surgical site infection (95% confidence interval, 0.45–0.90; P less than .01).


The study, published in the March edition of Surgical Endoscopy, also showed that dual-ring wound protectors were associated with a highly significant 69% reduction in the odds of surgical site infections (95% CI, 0.18-0.52; P less than .0001), while the benefits of single-ring wound protectors did not reach statistical significance (OR, 0.84; 95% CI, 0.67–1.04; P = .11).

Wound protectors – also known as wound guards or wound retractors – are intended to prevent the edges of a surgical wound from coming into contact with the contaminated surgical field.

The single-ring model consists of a plastic ring that sits within the wound and a protective drape that extends out from it. In the dual-ring model, one ring sits inside the wound and the other outside the wound, with the two rings joined by the protective plastic.

Of the 12 studies included in the meta-analysis, 5 involved colorectal surgery only, 5 included both colorectal and other gastrointestinal surgery, and 2 studies focused on appendectomies. All but one study involved open surgery.

“Our study is more specific in the interventions included in that we included lower gastrointestinal surgery only, which is a population that would likely benefit the most from the intervention due to the high incidence of SSIs in bowel surgery, compared to other abdominal surgeries,” wrote Lisa Zhang, MD, a general surgery resident at the department of surgery at Kingston (Ont.) General Hospital and her coauthors.

There was no difference in the effect of wound protectors based on the target organ for surgery, even with a high number of patients in one of the appendectomy trials, which the authors were concerned may have skewed the results.

Overall, the authors rated the evidence to be of moderate quality, but several studies had a high risk of bias.

The authors said that one barrier to routine use of these devices was cost. However, given that surgical site infections are estimated to cost around $3.5 billion to $10 billion annually in health care expenditures, they argued that “the use of dual-ring wound edge protectors should be considered in open lower gastrointestinal surgery, including open appendectomies.”

No funding sources or conflicts of interest were declared.

SOURCE: Zhang L et al. Surg Endosc. 2018;32:1111–22.