Groin Surgical Site Infection in Vascular Surgery: Systemic Review on Peri-Operative Antibiotic Prophylaxis

Abstract

Objectives: Surgical site infections (SSIs) in lower extremity vascular surgeries, post-groin incision, are not only common complications and significant contributors to patient mortality and morbidity, but also major financial burdens on healthcare systems and patients. In spite of recent advances in pre- and post-operative care, SSI rates in the vascular surgery field remain significant. However, compliant antibiotic therapy can successfully reduce the SSI incidence pre- and post-surgery. Methods: In October 2021, we conducted a systematic literature review using OVID, PubMed, and EMBASE databases, centered on studies published between January 1980 and December 2020. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist. Inclusion/exclusion criteria have been carefully selected and reported in the text. For analyses, we calculated 95% confidence intervals (CI) and weighted odds ratios to amalgamate control and study groups in publications. We applied The Cochrane Collaboration tool to assess bias risk in selected studies. Results: In total, 592 articles were identified. After the removal of duplicates and excluded studies, 36 full-texts were included for review. Conclusions: The review confirmed that antibiotic therapy, administered according to all peri-operative protocols described, is useful in reducing groin SSI rate in vascular surgery.

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

“…at preventing SSI after various types of vascular surgery (Table 2). Two of these studies also similarly reported that preincision antibiotics and iNPWT reduce the risk of SSI 51–55 . Another also reported that the use of subcuticular sutures instead of staples reduced the risk of SSI after vascular surgery requiring a groin incision 55 .…”

“…Two of these studies also similarly reported that preincision antibiotics and iNPWT reduce the risk of SSI. [51][52][53][54][55] Another also reported that the use of subcuticular sutures instead of staples reduced the risk of SSI after vascular surgery requiring a groin incision. 55 These systematic reviews did not examine all strategies intended to prevent SSI after lower limb revascularization surgery and variably used Grading of Recommendations, Assessment, Development, and Evaluation to assess certainty.…”

“…They also have important differences from ours. First, 2 included both RCTs and observational studies 54,55 . We restricted our included studies to RCTs to ensure an equal balance of both known and unknown confounders between study groups and across trials (assuming adequate randomization) 56 .…”

“…First, 2 included both RCTs and observational studies. 54,55 We restricted our included studies to RCTs to ensure an equal balance of both known and unknown confounders between study groups and across trials (assuming adequate randomization). 56 This may provide effect estimates with minimal to no residual confounding by indication.…”

“…Systematic reviews and meta-analyses [51][52][53][54][55] have previously examined the efficacy of iNPWT, [51][52][53] preincision antibiotics, 54 and various wound adjuncts 55 (wound drains, subcuticular sutures, etc.) at preventing SSI after various types of vascular surgery (Table 2).…”