Perioperative, Local and Systemic Warming to Prevent Surgical Site Infection

A Systematic Review and Meta-Analysis

Karen Ousey, Karen Leigh Edward, Sun Lui, John Stephenson, Kim Walker, Jed Duff, David Leaper

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Surgical site infection (SSI) is a common cause of postoperative morbidity. Perioperative hypothermia may contribute to surgical complications including increased risk of SSI. In this systematic review and meta-analysis the effectiveness of active and passive perioperative warming interventions to prevent SSI was compared with standard (non-warming) care.
Methods: Ovid MEDLINE; Ovid EMBASE; EBSCO CINAHL Plus; The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials were searched with no restrictions on language, publication date or study setting for randomised controlled trials (RCTs) and cluster RCTs; including adult patients undergoing elective or emergency surgery under general anaesthesia, receiving any active or passive warming intervention perioperatively. Two review authors independently performed study selection, risk of bias assessment and data extraction. Outcomes studied were SSI (primary outcome), inpatient mortality, hospital length of stay and pain (secondary outcomes).
Results: Four studies, including 768 patients, were identified. The risk ratio for SSI in warming groups was 0.36 (95% confidence interval [CI]: (0.23, 0.56); p<0. 001). Length of hospitalisation was 1.13 days less in warming groups (95% CI: (-3.07, 5.33); p=0.600). The risk ratio for mortality in the warming groups was 0.77 (95% CI: (0.17, 3.43); p=0.730). A meta-analysis for pain outcome could not be conducted.
Interpretations: This review provides evidence in favour of active warming to prevent SSI, but insufficient evidence of active warming to reduce length of hospital stay and mortality. Benefits of passive warming remain unclear and warrant further research.
Original languageEnglish
Pages (from-to)614-624
Number of pages11
JournalJournal of wound care
Volume26
Issue number11
Early online date13 Nov 2017
DOIs
Publication statusPublished - Nov 2017

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Surgical Wound Infection
Meta-Analysis
Length of Stay
Confidence Intervals
Randomized Controlled Trials
Odds Ratio
Pain
Mortality
Selection Bias
Hospital Mortality
Hypothermia
MEDLINE
General Anesthesia
Publications
Inpatients
Hospitalization
Emergencies
Language
Morbidity
Wounds and Injuries

Cite this

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title = "Perioperative, Local and Systemic Warming to Prevent Surgical Site Infection: A Systematic Review and Meta-Analysis",
abstract = "Objective: Surgical site infection (SSI) is a common cause of postoperative morbidity. Perioperative hypothermia may contribute to surgical complications including increased risk of SSI. In this systematic review and meta-analysis the effectiveness of active and passive perioperative warming interventions to prevent SSI was compared with standard (non-warming) care.Methods: Ovid MEDLINE; Ovid EMBASE; EBSCO CINAHL Plus; The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials were searched with no restrictions on language, publication date or study setting for randomised controlled trials (RCTs) and cluster RCTs; including adult patients undergoing elective or emergency surgery under general anaesthesia, receiving any active or passive warming intervention perioperatively. Two review authors independently performed study selection, risk of bias assessment and data extraction. Outcomes studied were SSI (primary outcome), inpatient mortality, hospital length of stay and pain (secondary outcomes).Results: Four studies, including 768 patients, were identified. The risk ratio for SSI in warming groups was 0.36 (95{\%} confidence interval [CI]: (0.23, 0.56); p<0. 001). Length of hospitalisation was 1.13 days less in warming groups (95{\%} CI: (-3.07, 5.33); p=0.600). The risk ratio for mortality in the warming groups was 0.77 (95{\%} CI: (0.17, 3.43); p=0.730). A meta-analysis for pain outcome could not be conducted.Interpretations: This review provides evidence in favour of active warming to prevent SSI, but insufficient evidence of active warming to reduce length of hospital stay and mortality. Benefits of passive warming remain unclear and warrant further research.",
keywords = "Surgical site infection, Perioperative, Warming, Systematic review, Meta analysis",
author = "Karen Ousey and Edward, {Karen Leigh} and Sun Lui and John Stephenson and Kim Walker and Jed Duff and David Leaper",
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Perioperative, Local and Systemic Warming to Prevent Surgical Site Infection : A Systematic Review and Meta-Analysis. / Ousey, Karen; Edward, Karen Leigh; Lui, Sun; Stephenson, John; Walker, Kim; Duff, Jed; Leaper, David.

In: Journal of wound care, Vol. 26, No. 11, 11.2017, p. 614-624.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Perioperative, Local and Systemic Warming to Prevent Surgical Site Infection

T2 - A Systematic Review and Meta-Analysis

AU - Ousey, Karen

AU - Edward, Karen Leigh

AU - Lui, Sun

AU - Stephenson, John

AU - Walker, Kim

AU - Duff, Jed

AU - Leaper, David

PY - 2017/11

Y1 - 2017/11

N2 - Objective: Surgical site infection (SSI) is a common cause of postoperative morbidity. Perioperative hypothermia may contribute to surgical complications including increased risk of SSI. In this systematic review and meta-analysis the effectiveness of active and passive perioperative warming interventions to prevent SSI was compared with standard (non-warming) care.Methods: Ovid MEDLINE; Ovid EMBASE; EBSCO CINAHL Plus; The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials were searched with no restrictions on language, publication date or study setting for randomised controlled trials (RCTs) and cluster RCTs; including adult patients undergoing elective or emergency surgery under general anaesthesia, receiving any active or passive warming intervention perioperatively. Two review authors independently performed study selection, risk of bias assessment and data extraction. Outcomes studied were SSI (primary outcome), inpatient mortality, hospital length of stay and pain (secondary outcomes).Results: Four studies, including 768 patients, were identified. The risk ratio for SSI in warming groups was 0.36 (95% confidence interval [CI]: (0.23, 0.56); p<0. 001). Length of hospitalisation was 1.13 days less in warming groups (95% CI: (-3.07, 5.33); p=0.600). The risk ratio for mortality in the warming groups was 0.77 (95% CI: (0.17, 3.43); p=0.730). A meta-analysis for pain outcome could not be conducted.Interpretations: This review provides evidence in favour of active warming to prevent SSI, but insufficient evidence of active warming to reduce length of hospital stay and mortality. Benefits of passive warming remain unclear and warrant further research.

AB - Objective: Surgical site infection (SSI) is a common cause of postoperative morbidity. Perioperative hypothermia may contribute to surgical complications including increased risk of SSI. In this systematic review and meta-analysis the effectiveness of active and passive perioperative warming interventions to prevent SSI was compared with standard (non-warming) care.Methods: Ovid MEDLINE; Ovid EMBASE; EBSCO CINAHL Plus; The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials were searched with no restrictions on language, publication date or study setting for randomised controlled trials (RCTs) and cluster RCTs; including adult patients undergoing elective or emergency surgery under general anaesthesia, receiving any active or passive warming intervention perioperatively. Two review authors independently performed study selection, risk of bias assessment and data extraction. Outcomes studied were SSI (primary outcome), inpatient mortality, hospital length of stay and pain (secondary outcomes).Results: Four studies, including 768 patients, were identified. The risk ratio for SSI in warming groups was 0.36 (95% confidence interval [CI]: (0.23, 0.56); p<0. 001). Length of hospitalisation was 1.13 days less in warming groups (95% CI: (-3.07, 5.33); p=0.600). The risk ratio for mortality in the warming groups was 0.77 (95% CI: (0.17, 3.43); p=0.730). A meta-analysis for pain outcome could not be conducted.Interpretations: This review provides evidence in favour of active warming to prevent SSI, but insufficient evidence of active warming to reduce length of hospital stay and mortality. Benefits of passive warming remain unclear and warrant further research.

KW - Surgical site infection

KW - Perioperative

KW - Warming

KW - Systematic review

KW - Meta analysis

UR - http://www.magonlinelibrary.com/toc/jowc/current

U2 - 10.12968/jowc.2017.26.11.614

DO - 10.12968/jowc.2017.26.11.614

M3 - Article

VL - 26

SP - 614

EP - 624

JO - Journal of wound care

JF - Journal of wound care

SN - 0969-0700

IS - 11

ER -