Antibiotic Versus Saline Irrigation During Open Appendectomy: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials.
Abdullatif Alfehaid, Abdullah M Alharran, Saud Jaber Almarri et al.
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In 30 seconds
This systematic review and random-effects meta-analysis assessed antibiotic versus saline irrigation during open appendectomy, including five randomized controlled trials with 1,080 patients. Surgical site infection occurred in 4.8% (26/533) of patients receiving antibiotic irrigation and 8.9% (49/547) receiving saline; the pooled risk ratio was 0.60 (95% CI: 0.36 to 0.99; p = 0.05). However, leave-one-out analyses showed fragility, and trial sequential analysis did not reach the required information size, so the evidence remains inconclusive. No significant differences were found in other reported outcomes.
Key findings
- SSI occurred in 4.8% (26/533) with antibiotic irrigation versus 8.9% (49/547) with saline (RR 0.60, 95% CI: 0.36 to 0.99; p = 0.05).
- Trial sequential analysis crossed the conventional boundary but not the monitoring boundary; the required information size was not reached.
- No significant differences were observed in abdominal abscess, post-operative ileus, length of stay, or operative duration.
Why it matters
Preventing surgical site infection is an important aim after open appendectomy, and the pooled results suggest antibiotic irrigation could reduce infection compared with saline. Yet the apparent benefit is sensitive to omission of individual trials, and sequential analysis indicates that the evidence is not conclusive. The findings therefore inform the uncertainty around this intra-operative measure rather than establishing a reliable effect.
What to keep in mind
Only five trials were included, mean follow-up was 1.1 months, and leave-one-out analyses showed fragile significance. Trial sequential analysis found the required information size had not been reached.