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Cochrane Database of Systematic Reviews

Cierre subcutáneo versus ningún cierre subcutáneo después de los procedimientos quirúrgicos no relacionados con la cesárea

Información

DOI:
https://doi.org/10.1002/14651858.CD010425.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 21 enero 2014see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Heridas

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Contraer

Autores

  • Kurinchi Selvan Gurusamy

    Correspondencia a: Department of Surgery, Royal Free Campus, UCL Medical School, London, UK

    [email protected]

  • Clare D Toon

    Public Health, West Sussex County Council, Chichester, UK

  • Brian R Davidson

    Department of Surgery, Royal Free Campus, UCL Medical School, London, UK

Contributions of authors

KS Gurusamy conceived the review question; developed and co‐ordinated the review; secured funding; completed the first draft of the review; advised on, wrote, edited and made an intellectual contribution to the review; approved the final version prior to submission, and is its guarantor.
Clare Toon extracted data, made an intellectual contribution to the review and approved the final version prior to submission.
Brian Davidson conceived the review question; secured funding; made an intellectual contribution; advised on part of the review and approved the final version prior to submission.

Contributions of editorial base

Nicky Cullum: edited the review; advised on methodology, interpretation and review content.
Susan O'Meara: Editor; approved the final review prior to submission.
Sally Bell‐Syer: co‐ordinated the editorial process; advised on methodology, interpretation and content; and edited the review.
Ruth Foxlee: designed the search strategy and edited the search methods section.
Rachel Richardson: edited the review.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • National Institute for Health Research, UK.

    National Institute for Health Research, the health research wing of the UK Government Department of Health funds K Gurusamy to complete this review.

  • The National Institute for Health Research (NIHR) is the sole funder of the Cochrane Wounds Review Group, UK.

Declarations of interest

This project was funded by the National Institute for Health Research (NIHR).

Disclaimer

Department of Health disclaimer: The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS (National Health Service), or the Department of Health.

KS Gurusamy: no known conflict of interest
Clare Toon: no known conflict of interest
Brian Davidson: no known conflict of interest

Acknowledgements

The authors would like to acknowledge the contribution of the Wounds Group editor (Julie Bruce), peer referees (Susanne Hempel; Robert Wyllie; Christine Fyfe), Statistical editor (Elmer Villanueva), and copy editor Elizabeth Royle, for their role in improving the review. To Ms Tina Sedaghati, who helped with the translation of Nouraei 2010.

Version history

Published

Title

Stage

Authors

Version

2014 Jan 21

Subcutaneous closure versus no subcutaneous closure after non‐caesarean surgical procedures

Review

Kurinchi Selvan Gurusamy, Clare D Toon, Brian R Davidson

https://doi.org/10.1002/14651858.CD010425.pub2

2013 Mar 28

Subcutaneous closure versus no subcutaneous closure after non‐obstetric surgical procedures

Protocol

Kurinchi Selvan Gurusamy, Brian R Davidson

https://doi.org/10.1002/14651858.CD010425

Differences between protocol and review

A new outcome "Impact to the patient (in terms of return to activity and return to work) and to the healthcare funder (in terms of costs related to dressings or treatment related to wound complications)" was added, as this outcome will permit assessment of the impact of any difference in incidence of wound complications for both participants and healthcare funders.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram
Figuras y tablas -
Figure 1

Study flow diagram

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 1 Superficial surgical site infection.
Figuras y tablas -
Analysis 1.1

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 1 Superficial surgical site infection.

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 2 Superficial wound dehiscence.
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Analysis 1.2

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 2 Superficial wound dehiscence.

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 3 Deep wound dehiscence.
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Analysis 1.3

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 3 Deep wound dehiscence.

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 4 Hospital stay.
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Analysis 1.4

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 4 Hospital stay.

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 5 Superficial surgical site infection (sensitivity analysis ‐ missing data imputation).
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Analysis 1.5

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 5 Superficial surgical site infection (sensitivity analysis ‐ missing data imputation).

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 6 Hospital stay (sensitivity analysis).
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Analysis 1.6

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 6 Hospital stay (sensitivity analysis).

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 7 Superficial surgical site infection (sensitivity analysis ‐ > 30 days).
Figuras y tablas -
Analysis 1.7

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 7 Superficial surgical site infection (sensitivity analysis ‐ > 30 days).

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Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 8 Superficial wound dehiscence (sensitivity analysis ‐ > 30 days).
Figuras y tablas -
Analysis 1.8

Comparison 1 Subcutaneous closure versus no subcutaneous closure, Outcome 8 Superficial wound dehiscence (sensitivity analysis ‐ > 30 days).

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Summary of findings for the main comparison. Subcutaneous closure compared to no subcutaneous closure for non‐caesarean surgery

Subcutaneous closure compared to no subcutaneous closure for non‐caesarean surgery

Patient or population: participants having non‐caesarean surgery
Settings: secondary
Intervention: subcutaneous closure of incision
Comparison: no subcutaneous closure of incision

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

No subcutaneous closure

Subcutaneous closure

Superficial surgical site infection

83 per 1000

70 per 1000
(44 to 110)

RR 0.84
(0.53 to 1.33)

815
(6 studies)

⊕⊝⊝⊝
very low1,2

Superficial wound dehiscence

103 per 1000

58 per 1000
(23 to 145)

RR 0.56
(0.22 to 1.41)

215
(2 studies)

⊕⊝⊝⊝
very low1,2

Deep wound dehiscence

133 per 1000

33 per 1000
(4 to 281)

RR 0.25
(0.03 to 2.11)

60
(1 study)

⊕⊝⊝⊝
very low1,2

Hospital stay

The mean hospital stay in the control groups was
6 days

The mean hospital stay in the intervention groups was
0.1 higher
(0.45 lower to 0.64 higher)

434
(3 studies)

⊕⊝⊝⊝
very low1,3

*The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: we are very uncertain about the estimate

1 The trial(s) was (were) of high risk of bias
2 The confidence intervals overlapped 1 and either 0.75 or 1.25 or both. The number of events in the intervention and control group was fewer than 300
3 There was severe heterogeneity as noted by the I2 statistic and the lack of overlap of confidence intervals

Figuras y tablas -
Summary of findings for the main comparison. Subcutaneous closure compared to no subcutaneous closure for non‐caesarean surgery
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Comparison 1. Subcutaneous closure versus no subcutaneous closure

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Superficial surgical site infection Show forest plot

6

815

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.53, 1.33]

2 Superficial wound dehiscence Show forest plot

2

215

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.22, 1.41]

3 Deep wound dehiscence Show forest plot

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.11]

4 Hospital stay Show forest plot

3

434

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.45, 0.64]

5 Superficial surgical site infection (sensitivity analysis ‐ missing data imputation) Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Best‐best analysis

6

824

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.52, 1.32]

5.2 Best‐worst analysis

6

824

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.47, 1.16]

5.3 Worst‐best analysis

6

824

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.63, 1.52]

5.4 Worst‐worst analysis

6

824

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.57, 1.33]

6 Hospital stay (sensitivity analysis) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7 Superficial surgical site infection (sensitivity analysis ‐ > 30 days) Show forest plot

3

434

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.25, 1.19]

8 Superficial wound dehiscence (sensitivity analysis ‐ > 30 days) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Subcutaneous closure versus no subcutaneous closure
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