Page 49 - International guidelines for groin hernia management

Hernia

analysis accounts for this variation and defines average- environments and analyzed for potential benefit of antibi-
risk patients as those with primary hernias and minimal otic prophylaxis. A total of seven studies with 2838
individual or operative risk factors. Of note, only elective patients comprise the low-risk environment group and ten
operations are included in the 17 RCTs. High-risk studies with 2871 patients make up the high-risk environ-
patients—with comorbidities like diabetes—are only ref- ment group.
erenced in two of the 17 articles, representing 8.3% of all The overall meta-analysis results of the RCTs have to be
patients. 603, 604 corrected for a large clinical diversity (inclusion criteria
There is a potential risk of resistance to the prophylactic variations regarding diabetes and recurrent hernia) and
antibiotic given varying between countries and different methodological diversity (surgical variations: drain use,
settings. This problem is not highlighted in any study. average surgical time, seroma aspiration, timing of shav-
The wound infection rates in the placebo groups varied ing) by using the random effect model.
widely, from 0 to 18%, likely reflecting the basal wound Wound infections occurred in 2.3% (33/1444) of the
infection rates in the study population. High wound low-risk environment placebo group and 1.6% (23/1394) of
infection rates were noted in studies from Pakistan, Turkey, the prophylaxis group, confirming a lack of evidence for
Japan and parts of India and Spain, and may reflect local prophylactic antibiotic benefit in the low-risk environment
differences in perioperative and operative practice. group (OR 0.72; 95% CI 0.42–1.24; NNT 158) (Fig. 3).
Highly regarded guidelines and expert opinions hold Nine (0.3%) surgical site infections occurred, with no
that a less than 5% wound infection rate in the placebo difference between placebo and prophylaxis groups.
group defines a low-risk environment. This cut-off has been
used for this analysis. 4, 601 Accordingly, the 17 RCTs have
been divided into those involving low- and high-risk

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