Primary versus delayed primary skin closure for prevention of surgical site infections in contaminated abdominal surgery: A meta-analysis of randomized controlled trials

Background and purpose of the study: Surgical site infections (SSIs) are one of the most common hospital acquired infections. Delayed primary skin closure (DPC) is a technique that can be used when there is a contaminated or dirty wound. The purpose of this study was to evaluate the effectiveness of DPC in reducing SSIs in dirty and contaminated abdominal surgeries compared to primary skin closure (PC).Methods: An electronic search was conducted using six databases and clinical trials registers, only randomized controlled trials (RCTs) were included. selection of the included studies and data extraction were conducted by more than one reviewer independently. All of the included studies were assessed for the risk of bias. Pooling of the data was performed for surgical site infections as a primary outcome, and the length of hospital stay.Main findings:12 RCTs were included in the final analysis, including 1456 patients that were randomized to receive either PC or DPC. Complicated appendicitis was the most common type of wounds with a percentage of (82.8%). Pooling of the data showed a significant difference between the two methods, and DPC was found effective in reducing the risk for SSI with a risk ratio of 0.56([95% CI:0.44, 0.72], P < 0.001). The length of hospital stay was slightly lower in the PC group with a mean difference of 0.25(95% CI:0.02, 0.48) days from DPC group.Conclusions: DPC might be more effective than PC in reducing the risk of SSIs, however most of the studies included in this meta-analysis conveyed a high risk of bias, hence more well-designed RCTs are recommended in this area.