144


Aurora Pop-Vicas et al


Fig. 1. Flowchart of study selection from the literature review. *Studies included obstetric-gynecological surgeries other than hysterectomy. Abbreviation: SSI, surgical site infection.


surgeries other than hysterectomy in 95 of 798 patients enrolled (12%). Clinical outcomes for this study were reported based on randomized antimicrobial drug arm, but they were not stratified by type of surgery performed. Meta-analyses with and outside this study showed no significant differences in results. We, therefore, chose to retain this study into our final analysis because of its relatively large sample size and because the majority (88%) of the patients underwent abdominal hysterectomy.


Antimicrobial prophylaxis characteristics


There was significant clinical heterogeneity among studies regarding antimicrobial prophylaxis choice and dosing, with anti- microbials administered in varying doses, either as a single pre- operative dose in some studies, or as additional postoperative doses within first 48 hours of surgery in others (Table 1). None of the studies specified whether antimicrobial dosing was adjusted based on patient’s weight/body mass index and/or renal clearance, although 2 studies did specify antimicrobial redosing intraopera- tively for extensive blood loss or surgery duration>3hours.20,24


Clinical outcome definitions and reporting


Definitions and reporting for the clinical outcome of our interest, SSI, were generally consistent between studies. They included the


following terms: surgical wound infection, vaginal cuff infection, postoperative vaginal wound infection, infected pelvic abscess or hematoma, pelvic infection requiring parenteral antimicrobial therapy, abdominal wound infection, pelvic cellulitis. We also included the following phrases: “any surgical wound which drained purulent or serous material, together with or without positive cultures” and “pelvic infection, defined as fever plus ≥1of the following: purulent drainage from the vaginal cuff, abdominal pain with rebound tenderness and/or guarding, localized ten- derness with a tender adnexal mass on bimanual palpation, or bacteremia with or without hypotension” (Table 1).


Study quality and risk of bias


Details related to randomization, such as the randomization sequence for treatment allocation, and details related to treatment concealment and blinding were not reported in 5 studies,17,19,21–23 and were not present in 3 studies,18,20,24 rendering 8 studies at indeterminate and high risk of bias, respectively. An intention-to- treat analysis was performed in only 1 study.25 Table 3 shows details related to risk of bias for the studies included in the sys- tematic review and meta-analysis. As shown by the funnel plot in Figure 2, publication bias was


not present, and the Egger test of the intercept lacked statistical significance (P=.11).


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149  |  Page 150  |  Page 151  |  Page 152  |  Page 153  |  Page 154  |  Page 155  |  Page 156