{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:17:40Z","timestamp":1793301460321,"version":"4.5.0"},"reference-count":70,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"Importance<\/jats:title>Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.<\/jats:p><\/jats:sec>Data Sources<\/jats:title>PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.<\/jats:p><\/jats:sec>Study Selection<\/jats:title>Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.<\/jats:p><\/jats:sec>Data Extraction and Synthesis<\/jats:title>This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.<\/jats:p><\/jats:sec>Main Outcome and Measure<\/jats:title>The primary study outcome was SSI.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17\u202f188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2024.0775","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T15:33:27Z","timestamp":1713972807000},"page":"792","source":"Crossref","is-referenced-by-count":60,"title":["Incisional Wound Irrigation for the Prevention of Surgical Site Infection"],"prefix":"10.1001","volume":"159","author":[{"given":"Hannah","family":"Groenen","sequence":"first","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands"},{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Bontekoning","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands"},{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasti","family":"Jalalzadeh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands"},{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis R.","family":"Buis","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"},{"name":"Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmine E. M.","family":"Dreissen","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"},{"name":"Department of Neurosurgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon H. M.","family":"Goosen","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"},{"name":"Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitske","family":"Graveland","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchel","family":"Griekspoor","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"},{"name":"Dutch Association of Medical Specialists, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank F. A.","family":"IJpma","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"},{"name":"Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten J.","family":"van der Laan","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"},{"name":"Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roald R.","family":"Schaad","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"},{"name":"Department of Anaesthesiology, Leiden University Medical Centre, Leiden, the Netherlands"},{"name":"Dutch Association of Anaesthesiology (NVA), the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrique","family":"Segers","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"},{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wil C.","family":"van der Zwet","sequence":"additional","affiliation":[{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"},{"name":"Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center+, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo G.","family":"Orsini","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Eskes","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"},{"name":"Amsterdam Public Health, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Wolfhagen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands"},{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stijn W.","family":"de Jonge","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marja A.","family":"Boermeester","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, the Netherlands"},{"name":"Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"key":"soi240019r1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2021.106136","article-title":"Worldwide incidence of surgical site infections in general surgical patients: a systematic review and meta-analysis of 488?594 patients.","volume":"95","author":"Gillespie","year":"2021","journal-title":"Int J Surg"},{"issue":"1","key":"soi240019r2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jhin.2017.03.004","article-title":"Impact of surgical site infection on health care costs and patient outcomes: a systematic review in 6 European countries.","volume":"96","author":"Badia","year":"2017","journal-title":"J Hosp Infect"},{"issue":"4","key":"soi240019r3","doi-asserted-by":"publisher","first-page":"222","DOI":"10.5662\/wjm.v11.i4.222","article-title":"Wound irrigation for preventing surgical site infections.","volume":"11","author":"Papadakis","year":"2021","journal-title":"World J Methodol"},{"issue":"8","key":"soi240019r5","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017.","volume":"152","author":"Berr\u00edos-Torres","year":"2017","journal-title":"JAMA Surg"},{"issue":"12","key":"soi240019r7","doi-asserted-by":"publisher","first-page":"e288","DOI":"10.1016\/S1473-3099(16)30402-9","article-title":"New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective.","volume":"16","author":"Allegranzi","year":"2016","journal-title":"Lancet Infect Dis"},{"issue":"10","key":"soi240019r8","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012234.pub2","article-title":"Intracavity lavage and wound irrigation for prevention of surgical site infection.","volume":"10","author":"Norman","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"soi240019r9","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1089\/sur.2019.318","article-title":"Intracavity lavage and wound irrigation for prevention of surgical site infection: systematic review and network meta-analysis.","volume":"22","author":"Thom","year":"2021","journal-title":"Surg Infect (Larchmt)"},{"issue":"1","key":"soi240019r10","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s13017-023-00496-6","article-title":"Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis.","volume":"18","author":"Zhou","year":"2023","journal-title":"World J Emerg Surg"},{"key":"soi240019r11","doi-asserted-by":"publisher","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"issue":"4","key":"soi240019r12","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1086\/501620","article-title":"Guideline for prevention of surgical site infection, 1999.","volume":"20","author":"Mangram","year":"1999","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"4","key":"soi240019r13","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1089\/sur.2016.272","article-title":"Systematic review and meta-analysis of randomized controlled trials evaluating prophylactic intraoperative wound irrigation for the prevention of surgical site infections.","volume":"18","author":"de Jonge","year":"2017","journal-title":"Surg Infect (Larchmt)"},{"issue":"2","key":"soi240019r15","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1080\/00031305.2016.1154108","article-title":"The ASA statement on P values: context, process, and purpose.","volume":"70","author":"Wasserstein","year":"2016","journal-title":"Am Stat"},{"key":"soi240019r16","doi-asserted-by":"publisher","first-page":"g5630","DOI":"10.1136\/bmj.g5630","article-title":"A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis.","volume":"349","author":"Puhan","year":"2014","journal-title":"BMJ"},{"key":"soi240019r17","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.jclinepi.2021.07.011","article-title":"GRADE guidelines 33: addressing imprecision in a network meta-analysis.","volume":"139","author":"Brignardello-Petersen","year":"2021","journal-title":"J Clin Epidemiol"},{"key":"soi240019r18","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials.","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"issue":"7109","key":"soi240019r19","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test.","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"issue":"16","key":"soi240019r20","doi-asserted-by":"publisher","first-page":"2992","DOI":"10.1002\/sim.v38.16","article-title":"Network meta-analysis of rare events using the Mantel-Haenszel method.","volume":"38","author":"Efthimiou","year":"2019","journal-title":"Stat Med"},{"issue":"4","key":"soi240019r22","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.37506\/ijfmt.v15i4","article-title":"Topical application of povidone iodine to minimize post appendectomy wound infection.","volume":"15","author":"Al-Abdulla","year":"2021","journal-title":"Indian J Forensic Med Toxicol"},{"issue":"1","key":"soi240019r23","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.ijgo.2006.03.030","article-title":"Saline irrigation and wound infection in abdominal gynecologic surgery.","volume":"94","author":"Al-Ramahi","year":"2006","journal-title":"Int J Gynaecol Obstet"},{"key":"soi240019r24","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.ejogrb.2018.06.006","article-title":"The impact of subcutaneous irrigation on wound complications after cesarean sections: a prospective randomized study.","volume":"227","author":"Aslan \u00c7etin","year":"2018","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"1","key":"soi240019r25","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1258\/004947506775598923","article-title":"Wound infection after metronidazole infiltration.","volume":"36","author":"Bhargava","year":"2006","journal-title":"Trop Doct"},{"issue":"1","key":"soi240019r26","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/s002689910008","article-title":"Syringe pressure irrigation of subdermic tissue after appendectomy to decrease the incidence of postoperative wound infection.","volume":"24","author":"Cervantes-S\u00e1nchez","year":"2000","journal-title":"World J Surg"},{"issue":"6","key":"soi240019r27","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1007\/s00586-005-0975-6","article-title":"Can povidone-iodine solution be used safely in a spinal surgery?","volume":"15","author":"Chang","year":"2006","journal-title":"Eur Spine J"},{"issue":"15","key":"soi240019r28","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1097\/01.brs.0000171907.60775.85","article-title":"Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery.","volume":"30","author":"Cheng","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"issue":"10","key":"soi240019r29","doi-asserted-by":"publisher","first-page":"e994","DOI":"10.1097\/BPO.0000000000001620","article-title":"Why irrigate for the same contamination rate: wound contamination in pediatric spinal surgery using betadine vs saline.","volume":"40","author":"Cohen","year":"2020","journal-title":"J Pediatr Orthop"},{"key":"soi240019r30","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/7218918","article-title":"Intraoperative disinfection by pulse irrigation with povidone-iodine solution in spine surgery.","volume":"2017","author":"De Luna","year":"2017","journal-title":"Adv Orthop"},{"key":"soi240019r31","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.ijsu.2020.07.057","article-title":"A randomized controlled trial on irrigation of open appendectomy wound with gentamicin-saline solution vs saline solution for prevention of surgical site infection.","volume":"81","author":"Emile","year":"2020","journal-title":"Int J Surg"},{"issue":"2","key":"soi240019r32","first-page":"6","article-title":"Cefazoline or normal saline irrigation doesn\u2019t reduce surgical site infections after cesarean.","volume":"1","author":"Etaati","year":"2012","journal-title":"Int Electron J Med"},{"key":"soi240019r33","doi-asserted-by":"publisher","first-page":"3010","DOI":"10.12659\/MSM.901868","article-title":"Comparison of lavage techniques for preventing incision infection following posterior lumbar interbody fusion.","volume":"23","author":"Fei","year":"2017","journal-title":"Med Sci Monit"},{"issue":"2","key":"soi240019r34","doi-asserted-by":"publisher","first-page":"25","DOI":"10.20953\/1726-1678-2022-2-25-32","article-title":"The effect of subcutaneous saline irrigation on wound complication after cesarean section: a randomized controlled trial.","volume":"21","author":"Gomaa","year":"2022","journal-title":"Vopr Ginekol Aku\u0161erstva Perinatol"},{"issue":"1","key":"soi240019r35","doi-asserted-by":"publisher","first-page":"8","DOI":"10.28982\/josam.842145","article-title":"The role of saline irrigation of subcutaneous tissue in preventing surgical site complications during cesarean section: a prospective randomized controlled trial.","volume":"5","author":"G\u00fcl","year":"2021","journal-title":"J Surg Med."},{"issue":"7","key":"soi240019r36","doi-asserted-by":"publisher","first-page":"662","DOI":"10.3109\/01443615.2010.494206","article-title":"Does saline irrigation reduce the wound infection in caesarean delivery?","volume":"30","author":"G\u00fcng\u00f6rd\u00fck","year":"2010","journal-title":"J Obstet Gynaecol"},{"issue":"3","key":"soi240019r37","first-page":"467","article-title":"Efficacy of irrigation with povidone iodine solution before skin closure to reduce surgical site infections in clean elective surgeries.","volume":"43","author":"Haider","year":"2018","journal-title":"Rawal Med J"},{"key":"soi240019r38","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.wneu.2022.12.134","article-title":"Prevention of Surgical site infection following open spine surgery: the efficacy of intraoperative wound irrigation with normal saline containing gentamicin vs dilute povidone-iodine.","volume":"173","author":"Inojie","year":"2023","journal-title":"World Neurosurg"},{"issue":"3","key":"soi240019r39","first-page":"160","article-title":"Effect of povidone-iodine irrigation on postappendectomy wound Infection: randomized control trial.","volume":"29","author":"Iqbal","year":"2015","journal-title":"J Postgrad Med Inst"},{"issue":"4","key":"soi240019r40","first-page":"205","article-title":"Topical rifampicin vs povidone-iodine for the prevention of incisional surgical site infections following benign gynecologic surgery: a prospective, randomized, controlled trial.","volume":"42","author":"Karuserci","year":"2019","journal-title":"New Microbiol"},{"issue":"9","key":"soi240019r41","doi-asserted-by":"publisher","first-page":"513","DOI":"10.5603\/GP.a2020.0134","article-title":"Subcutaneous rifampicin versus povidone-iodine for the prevention of incisional surgical site infections following gynecologic oncology surgery: a prospective, randomized, controlled trial.","volume":"91","author":"K\u00f6m\u00fcrc\u00fc Karuserci","year":"2020","journal-title":"Ginekol Pol"},{"issue":"5","key":"soi240019r42","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1080\/01443615.2021.1964453","article-title":"Subcutaneous irrigation with rifampicin vs povidone-iodine for the prevention of incisional surgical site infections following caesarean section: a prospective, randomised, controlled trial.","volume":"42","author":"K\u00f6m\u00fcrc\u00fc Karuserci","year":"2022","journal-title":"J Obstet Gynaecol"},{"key":"soi240019r43","doi-asserted-by":"publisher","first-page":"105","DOI":"10.55095\/achot2008\/018","article-title":"Efficacy of antiseptics in the prevention of postoperative infections of the proximal femur, hip, and pelvis regions in orthopedic pediatric patients\u2014analysis of the first results.","volume":"75","author":"Kokavec","year":"2008","journal-title":"Acta Chir Orthop Traumatol Cech"},{"issue":"3","key":"soi240019r44","first-page":"269","article-title":"Rifamycin SV application to subcutanous tissue for prevention of postcesarean surgical site infection.","volume":"7","author":"K\u00f6s\u00fcs","year":"2010","journal-title":"Eur J Gen Med"},{"issue":"5","key":"soi240019r45","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1097\/SLA.0000000000005786","article-title":"Aqueous povidone-iodine versus normal saline for intraoperative wound irrigation on the incidence of surgical site infection in clean-contaminated wounds after gastroenterological surgery: a single-institute, prospective, blinded\u2013end point, randomized controlled trial.","volume":"277","author":"Maemoto","year":"2023","journal-title":"Ann Surg"},{"issue":"9","key":"soi240019r46","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.jcms.2022.06.012","article-title":"The effect of 3 % hydrogen peroxide irrigation on postoperative complications of rhinoplasty: a double-blinded, placebo-controlled randomized clinical trial.","volume":"50","author":"Maghsoudipour","year":"2022","journal-title":"J Craniomaxillofac Surg"},{"issue":"3","key":"soi240019r47","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1111\/ajo.2016.56.issue-3","article-title":"The Betadine trial\u2014antiseptic wound irrigation prior to skin closure at caesarean section to prevent surgical site infection: a randomized controlled trial.","volume":"56","author":"Mahomed","year":"2016","journal-title":"Aust N Z J Obstet Gynaecol"},{"issue":"11","key":"soi240019r48","first-page":"71","article-title":"The effect of antibiotic irrigation of surgical incisions in prevention of surgical site infection.","volume":"65","author":"Mirsharifi","year":"2008","journal-title":"Tehran Univ Med J"},{"key":"soi240019r49","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.7985","article-title":"Intraoperative wound irrigation for the prevention of surgical site infection after laparotomy.","author":"Mueller","journal-title":"JAMA Surg"},{"issue":"4","key":"soi240019r50","doi-asserted-by":"publisher","first-page":"S1244","DOI":"10.1016\/S0016-5085(16)34202-0","article-title":"Effect of polyhexanide on the incidence of surgical site infections after colorectal surgery.","volume":"150","author":"Neeff","year":"2016","journal-title":"Gastroenterology"},{"issue":"11","key":"soi240019r51","doi-asserted-by":"publisher","first-page":"NP1521","DOI":"10.1093\/asj\/sjab290","article-title":"Postmastectomy surgical pocket irrigation with triple antibiotic solution vs chlorhexidine gluconate: a randomized controlled trial assessing surgical site infections in immediate tissue expander breast reconstruction.","volume":"41","author":"Nguyen","year":"2021","journal-title":"Aesthet Surg J"},{"issue":"6","key":"soi240019r52","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1080\/02688697.2020.1812518","article-title":"Intraoperative wound irrigation with ceftriaxone does not reduce surgical site infection in clean neurosurgical procedures.","volume":"35","author":"Okunlola","year":"2021","journal-title":"Br J Neurosurg"},{"issue":"6","key":"soi240019r53","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1089\/sur.2015.020","article-title":"Effect of lavage with gentamicin vs clindamycin vs physiologic saline on drainage discharge of the axillary surgical bed after lymph node dissection.","volume":"16","author":"Oller","year":"2015","journal-title":"Surg Infect (Larchmt)"},{"issue":"6","key":"soi240019r54","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1097\/01.sap.0000095656.18023.6b","article-title":"The effect of body mass index and wound irrigation on outcome after bilateral breast reduction.","volume":"51","author":"Platt","year":"2003","journal-title":"Ann Plast Surg"},{"issue":"5","key":"soi240019r55","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1016\/j.breast.2013.03.008","article-title":"Effect of gentamicin lavage of the axillary surgical bed after lymph node dissection on drainage discharge volume.","volume":"22","author":"Ruiz-Tovar","year":"2013","journal-title":"Breast"},{"issue":"8","key":"soi240019r56","doi-asserted-by":"publisher","first-page":"2184","DOI":"10.53350\/pjmhs2115","article-title":"Compare the incidence of surgical site infection after appendectomy wound irrigation with normal saline and imipenem solutions.","volume":"15","author":"Shah","year":"2021","journal-title":"Pak J Med Health Sci"},{"issue":"3","key":"soi240019r57","doi-asserted-by":"publisher","first-page":"314","DOI":"10.35975\/apic.v24i3.1282","article-title":"Operative site irrigation with povidone-iodine solution in spinal surgery for surgical site infection prevention: can it be used safety?","volume":"24","author":"Akhavan-Sigari","year":"2020","journal-title":"Anaesth Pain Intensi."},{"issue":"1","key":"soi240019r58","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1097\/SLA.0000000000003645","article-title":"Reduction of postoperative wound infections by antiseptica (RECIPE)?: a randomized controlled trial.","volume":"272","author":"Strobel","year":"2020","journal-title":"Ann Surg"},{"issue":"7","key":"soi240019r59","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1007\/DCR.0b013e318211b83a","article-title":"Application of an electrolyzed strongly acidic aqueous solution before wound closure in colorectal surgery.","volume":"54","author":"Takesue","year":"2011","journal-title":"Dis Colon Rectum"},{"issue":"2","key":"soi240019r60","doi-asserted-by":"publisher","DOI":"10.4172\/2161-1076","article-title":"Comparison of the efficacy of povidone-iodine and normal saline wash in preventing surgical site infections in laparotomy wounds-randomized controlled trial.","volume":"8","author":"Vinay","year":"2019","journal-title":"Surgery Curr Res"},{"issue":"2","key":"soi240019r61","doi-asserted-by":"publisher","first-page":"617","DOI":"10.53350\/pjmhs202317","article-title":"Compare the frequency of surgical site infections following irrigation of appendectomy wounds with sterile saline solution vs imipenem solution.","volume":"17","author":"Zeb","year":"2023","journal-title":"Pak J Med Sci"},{"key":"soi240019r62","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jhin.2022.10.005","article-title":"Comparing the efficacy of povidone-iodine and normal saline in incisional wound irrigation to prevent superficial surgical site infection: a randomized clinical trial in gastric surgery.","volume":"131","author":"Zhao","year":"2023","journal-title":"J Hosp Infect"},{"issue":"4","key":"soi240019r63","first-page":"277","article-title":"The antibiotic resistance crisis: part 1: causes and threats.","volume":"40","author":"Ventola","year":"2015","journal-title":"P T"},{"issue":"1","key":"soi240019r64","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1038\/s41598-022-26658-1","article-title":"Bacterial sensitivity to chlorhexidine and povidone-iodine antiseptics over time: a systematic review and meta-analysis of human-derived data.","volume":"13","author":"Aftab","year":"2023","journal-title":"Sci Rep"},{"issue":"1","key":"soi240019r65","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/s13756-022-01178-9","article-title":"Effect of povidone-iodine and propanol-based mecetronium ethyl sulphate on antimicrobial resistance and virulence in Staphylococcus aureus.","volume":"11","author":"Barakat","year":"2022","journal-title":"Antimicrob Resist Infect Control"},{"issue":"10","key":"soi240019r66","doi-asserted-by":"publisher","first-page":"e762","DOI":"10.1016\/S2666-5247(22)00187-2","article-title":"Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis.","volume":"3","author":"Jalalzadeh","year":"2022","journal-title":"Lancet Microbe"},{"issue":"4","key":"soi240019r67","doi-asserted-by":"publisher","first-page":"285","DOI":"10.2106\/JBJS.M.00313","article-title":"Selection of an optimal antiseptic solution for intraoperative irrigation: an in vitro study.","volume":"96","author":"van Meurs","year":"2014","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"soi240019r68","doi-asserted-by":"publisher","first-page":"S49","DOI":"10.1016\/j.ajic.2012.10.030","article-title":"Reducing the risk of surgical site infections: does chlorhexidine gluconate provide a risk reduction benefit?","volume":"41","author":"Edmiston","year":"2013","journal-title":"Am J Infect Control"},{"issue":"27","key":"soi240019r70","doi-asserted-by":"publisher","first-page":"2629","DOI":"10.1056\/NEJMoa1508502","article-title":"A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds.","volume":"373","author":"Bhandari","year":"2015","journal-title":"N Engl J Med"},{"key":"soi240019r6","volume-title":"Global Guidelines for the Prevention of Surgical Site Infection","author":"WHO","year":"2018","edition":"2nd ed"},{"key":"soi240019r4","unstructured":"National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. Accessed August 1, 2023. https:\/\/www.nice.org.uk\/guidance\/ng125"},{"key":"soi240019r14","unstructured":"Higgins? JPT, Thomas? J, Chandler? J, , eds. Cochrane Handbook for Systematic Reviews of Interventions, version 6.3. Accessed August 10, 2023. http:\/\/www.training.cochrane.org\/handbook"},{"key":"soi240019r21","unstructured":"Hamadeh? N, Van Rompaey? C, Metreau? E, Eapen? SG. New World Bank country classifications by income level: 2022-2023. Accessed July 15, 2023. https:\/\/blogs.worldbank.org\/opendata\/new-world-bank-country-classifications-income-level-2022-2023"},{"key":"soi240019r69","unstructured":"Watts? R, Solomons? T. Evidence summary: wound management\u2014chlorhexidine. Accessed July 30, 2023. https:\/\/www.curtin.edu.au\/resources\/file\/faculty\/hs\/wceihp-Chlorhexidine-.docx"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2817941\/jamasurgery_groenen_2024_oi_240019_1719948192.58347.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T15:09:53Z","timestamp":1720624193000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2817941"}},"subtitle":["A Systematic Review and Network Meta-Analysis"],"short-title":[],"issued":{"date-parts":[[2024,7,1]]},"references-count":70,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2024.0775","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2024,7,1]]}}}