Association between skin suture devices and incidence of incisional surgical site infection after gastrointestinal surgery: systematic review and network meta-analysis

K Kouzu; D Kabata; H Shinkawa; S Shinji; T Ishinuki; K Tamura; M Uchino; H Ohge; J Shimizu; S Haji; Y Mohri; C Yamashita; Y Kitagawa; K Suzuki; M Kobayashi; M Kobayashi; Y Hanai; H Nobuhara; H Imaoka; M Yoshida; T Mizuguchi; T Mayumi; Y Kitagawa

doi:10.1016/j.jhin.2024.04.029

Association between skin suture devices and incidence of incisional surgical site infection after gastrointestinal surgery: systematic review and network meta-analysis

J Hosp Infect. 2024 Aug:150:134-144. doi: 10.1016/j.jhin.2024.04.029. Epub 2024 Jun 19.

Authors

K Kouzu¹, D Kabata², H Shinkawa³, S Shinji⁴, T Ishinuki⁵, K Tamura⁶, M Uchino⁷, H Ohge⁸, J Shimizu⁹, S Haji¹⁰, Y Mohri¹¹, C Yamashita¹², Y Kitagawa¹³, K Suzuki¹⁴, M Kobayashi¹⁵, M Kobayashi¹⁶, Y Hanai¹⁷, H Nobuhara¹⁸, H Imaoka¹⁹, M Yoshida²⁰, T Mizuguchi⁵, T Mayumi²¹, Y Kitagawa²²

Affiliations

¹ Department of Surgery, National Defence Medical College, Saitama, Japan. Electronic address: dj27qd.t01312kk@gmail.com.
² Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
³ Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
⁴ Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
⁵ Department of Nursing, Division of Surgical Science, Sapporo Medical University, Hokkaido, Japan.
⁶ Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁷ Department of Gastroenterological Surgery, Division of Inflammatory Bowel Disease, Hyogo Medical University, Hyogo, Japan.
⁸ Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan.
⁹ Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
¹⁰ Department of Surgery, Soseikai General Hospital, Kyoto, Japan.
¹¹ Department of Surgery, Mie Prefectural General Medical Center, Mie, Japan.
¹² Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan.
¹³ Department of Infection Control, National Center for Geriatrics and Gerontology, Aichi, Japan.
¹⁴ Department of Infectious Disease Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
¹⁵ Department of Anesthesiology, Hokushinkai Megumino Hospital, Hokkaido, Japan.
¹⁶ Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Kitasato University, Tokyo, Japan.
¹⁷ Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Tokyo, Japan.
¹⁸ Department of Dentistry, Hiroshima Prefectural Hospital, Hiroshima, Japan.
¹⁹ Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.
²⁰ Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan.
²¹ Department of Intensive Care Unit, Japan Community Healthcare Organization Chukyo Hospital, Aichi, Japan.
²² Keio University, School of Medicine, Tokyo, Japan.

PMID: 38901769
DOI: 10.1016/j.jhin.2024.04.029

Abstract

Background: Surgical site infections (SSIs) are common complications after abdominal surgery.

Aim: To compare which suture devices could reduce the incidence of incisional surgical site infections (SSIs) after gastrointestinal surgery using a systematic review and network meta-analysis.

Methods: The CENTRAL, PubMed, and ICHUSHI-Web databases were searched from January 1^st, 2000, to December 31^st, 2022, for randomized clinical trials (RCTs) comparing the incidence of incisional SSI after gastrointestinal surgery among patients treated with different surgical suture devices, including non-absorbable sutures, absorbable sutures, skin staplers, and tissue adhesives (last searched in August 23^th, 2023). The risk of bias was assessed using the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. To estimate the pooled odds ratios (ORs) for each comparison, a fixed-effect inverse-variance model based on the Mantel-Haenszel approach was employed.

Findings: A total of 18 RCTs with 5496 patients were included in this study. The overall SSIs in absorbable sutures were significantly lower than those in skin staplers (OR: 0.77; 95% confidence intervals (CI): 0.63-0.95) and non-absorbable sutures (OR: 0.62; 95% CI: 0.39-0.99), whereas SSIs in absorbable sutures were not significantly different from the SSIs in tissue adhesive. The highest P-score was 0.91 for absorbable sutures. A funnel plot for estimating the heterogeneity of the studies revealed that a publication bias would be minimal (Egger test, P = 0.271).

Conclusion: This study showed that absorbable sutures reduced incisional SSIs in gastrointestinal surgical operations compared to any other suture devices.

Keywords: Absorbable sutures; Gastrointestinal surgery; Network meta-analysis; Subcuticular sutures; Surgical site infection; Systematic review.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Digestive System Surgical Procedures* / adverse effects
Humans
Incidence
Network Meta-Analysis
Randomized Controlled Trials as Topic
Surgical Wound Infection* / epidemiology
Surgical Wound Infection* / etiology
Surgical Wound Infection* / prevention & control
Sutures* / adverse effects