Efficacy of Strategies Intended to Prevent Surgical Site Infection After Lower Limb Revascularization Surgery

Abstract

Objective: The objective of this study is to evaluate the efficacy of strategies intended to prevent surgical site infection (SSI) after lower limb revascularization surgery. Background: SSIs are common, costly complications of lower limb revascularization surgery associated with significant morbidity and mortality. Methods: We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 28, 2022). Two investigators independently screened abstracts and full-text articles, extracted data, and assessed the risk of bias. We included randomized controlled trials (RCTs) that evaluated strategies intended to prevent SSI after lower limb revascularization surgery for peripheral artery disease. We used random-effects models to pool data and GRADE to assess certainty. Results: Among 6258 identified citations, we included 26 RCTs (n=4752 patients) that evaluated 12 strategies to prevent SSI. Preincision antibiotics [risk ratio (RR)=0.25; 95% CI, 0.11–0.57; n=4 studies; I 2 statistic=7.1%; high certainty] and incisional negative-pressure wound therapy (iNPWT) (RR=0.54; 95% CI, 0.38–0.78; n=5 studies; I 2 statistic=7.2%; high certainty) reduced pooled risk of early (≤30 days) SSI. iNPWT also reduced the risk of longer-term (>30 days) SSI (pooled-RR=0.44; 95% CI, 0.26–0.73; n=2 studies; I 2=0%; low certainty). Strategies with uncertain effects on risk of SSI included preincision ultrasound vein mapping (RR=0.58; 95% CI, 0.33–1.01; n=1 study); transverse groin incisions (RR=0.33; 95% CI, 0.097–1.15; n=1 study), antibiotic-bonded prosthetic bypass grafts (RR=0.74; 95% CI, 0.44–1.25; n=1 study; n=257 patients), and postoperative oxygen administration (RR=0.66; 95% CI, 0.42–1.03; n=1 study) (low certainty for all). Conclusions: Preincision antibiotics and iNPWT reduce the risk of early SSI after lower limb revascularization surgery. Confirmatory trials are required to determine whether other promising strategies also reduce SSI risk.

Prediction models of surgical site infection after gastrointestinal surgery: a nationwide prospective cohort study

“…In previous studies, insufficient randomised controlled trial evidence was found to evaluate the advantages and disadvantages of surgical antibiotic prophylaxis for SSI prevention 20 , 21 . However, the effect of surgical antibiotic prophylaxis on SSI remains unclear.…”

Significance and current approaches to vascular graft infection

“…This animal study showed that their specific antibiotic composition with minocycline and rifampin with chlorhexidine precoating resisted to Staphylococcus aureus and limited the growth of Pseudomonas aeruginosa . However, clinical experience is heterogenous and diverse surveys show mixed opinions about preventive usage of antibiotic-bonded grafts [ 31 , 32 ]. Furthermore, S. aureus has been shown to colonize rifampin-bonded grafts 7 days after implantation [ 33 ].…”