title: Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  A meta-analysis of randomized clinical trials (RCTs) was conducted to evaluate whether wound protectors reduce the risk of surgical site infection (SSI) after gastrointestinal and biliary tract surgery.
  
  
  BACKGROUND
  The effectiveness of impervious wound edge protectors for reduction of SSI remains unclear.
  
  
  METHODS
  A systematic review was conducted in Medline, EMBASE, and the Cochrane Library to identify RCTs that evaluate the risk of SSI after gastrointestinal and biliary surgeries with and without the use of an impervious wound protector. The pooled risk ratio was estimated with random-effect meta-analysis. Sensitivity analyses were performed to examine the impact of structural design of wound protector, publication year, study quality, inclusion of emergent surgeries, preoperative antibiotic administration, and bowel preparation on the pooled risk of SSI.
  
  
  RESULTS
  Of the 347 studies identified, 6 RCTs representing 1008 patients were included. The use of a wound protector was associated with a significant decrease in SSI (RR = 0.55, 95% CI 0.31-0.98, P = 0.04). There was a nonsignificant trend toward greater protective effect in studies using a dual ring protector (RR = 0.31, 95% CI 0.14-0.67, P = 0.003), rather than a single ring protector (RR = 0.83, 95% CI 0.38-1.83, P = 0.64). Publication year (P = 0.03) and blinding of outcome assessors (P = 0.04) significantly modified the effect of wound protectors on SSI.
  
  
  CONCLUSIONS
  Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery.
authors.affiliation: Division of General Surgery, University of Calgary, University of British Columbia, Canada.
authors.forename: Janet P
authors.initials: JP
authors.lastname: Edwards
authors.forename: Adelyn L
authors.initials: AL
authors.lastname: Ho
authors.forename: May C
authors.initials: MC
authors.lastname: Tee
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
mesh_terms: D001662:Biliary Tract Surgical Procedures; D013505:Digestive System Surgical Procedures; D004867:Equipment Design; D006801:Humans; D011482:Protective Devices; D016032:Randomized Controlled Trials as Topic; D058636:Surgical Drapes; D013530:Surgical Wound Infection / Q000517:prevention & control*