Comparison of early and delayed removal of dressing following primary closure of clean and contaminated surgical wounds: A systematic review and meta-analysis of randomized controlled trials

Taijuan Zhang, Fujie Zhang, Zongnan Chen, Xiuling Cheng, Taijuan Zhang, Fujie Zhang, Zongnan Chen, Xiuling Cheng

Abstract

The usefulness of dressing a surgical wound beyond the first 24-48 h of surgery is currently a controversial issue. The aim of this meta-analysis was to compare the early and delayed removal of dressing following primary closure in the management of clean and contaminated surgical wounds. Systematic searches were conducted in various databases including Medline, Cochrane Controlled Register of Trials (CENTRAL), Scopus, and Embase from January, 1964 until October, 2019. We used the Cochrane risk of bias tool to assess the quality of published trials. We carried out a meta-analysis with random-effects model and reported pooled risk ratios (RR) with 95% confidence intervals (CIs). In total, we analysed 10 studies with 1,708 participants. All the studies were randomized controlled trials, while the majority of studies had unclear or high bias risks. Early dressing removal was favoured with respect to surgical site infection (pooled RR=0.89; 95% CI: 0.61 to 1.29), patient's perception on safety (pooled RR=0.60; 95% CI: 0.48 to 0.76) and comfort (pooled RR=0.95; 95% CI: 0.74 to 1.22), while the remaining outcomes favoured delayed dressing removal. However, none of the factors had statistically significant difference between two interventions except the patient's perception on safety. To summarize, delayed removal of dressing is not superior to early removal following primary closure of clean or clean-contaminated surgical wounds.

Keywords: occlusive dressings; surgical wound; wound closure techniques; wounds and injuries.

Copyright: © Zhang et al.

Figures

Figure 1
Figure 1
PRISMA flow chart showing the selection of studies for the present review (n=10).
Figure 2
Figure 2
Forest plot showing the difference in surgical site infection between early and delayed dressing removal techniques (n=10).
Figure 3
Figure 3
Funnel plot checking for publication bias (n=10).
Figure 4
Figure 4
Forest plot showing the difference in surgical wound dehiscence between early and delayed dressing removal techniques (n=4).
Figure 5
Figure 5
Forest plot showing the difference in patient satisfaction between early and delayed dressing removal techniques (n=2).
Figure 6
Figure 6
Forest plot showing the difference in patient perception on safety between early and delayed dressing removal techniques (n=2).
Figure 7
Figure 7
Forest plot showing the difference in patient perception on comfort between early and delayed dressing removal techniques (n=2).
Figure 8
Figure 8
Forest plot showing the difference in patient perception on convenience between early and delayed dressing removal techniques (n=2).

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