The Efficacy of Antimicrobial-Coated Sutures for Preventing Incisional Surgical Site Infections in Digestive Surgery: a Systematic Review and Meta-analysis

Background Antimicrobial-coated sutures have recently become well known for preventing surgical site infections (SSIs). However, the evidence and recommendations from some organizations remain controversial. Therefore, we conducted a systematic review and meta-analysis to analyze the efficacy of antimicrobial-coated sutures for preventing SSIs in digestive surgery. Methods We performed a systematic review of literature published from 2000 to 2017 (registered on PROSPERO, No. CRD42017076780). We included studies defined as randomized controlled trials (RCTs) and observational studies (OBSs) for the prevention of SSIs and the reduction in hospital stay length associated with digestive surgery. Results In the 10 RCTs, the incidence rates of incisional SSIs were 160/1798 (8.9%) with coated sutures and 205/1690 (12.1%) with non-coated sutures. Overall, antimicrobial-coated sutures were superior for reducing the incidence of incisional SSI (risk ratio (RR) 0.67, 95% confidence intervals (CI) 0.48-0.94, p = 0.02) in RCTs for digestive surgery with the mixed wound class and surgeries limited to a clean-contaminated wound (RR 0.66, 95% CI 0.44-0.98, p = 0.04). A superior effect of antimicrobial-coated sutures was found in 9 RCTs that involved only colorectal surgeries (RR 0.69, 95% CI 0.49-0.98, p = 0.04). The mean hospital stay length was similar with coated or uncoated sutures in 5 RCTs involving colorectal surgery (mean difference (MD) - 5.00, 95% CI 16.68-6.69, p = 0.4). Conclusion Antimicrobial-coated sutures are significantly more efficacious for preventing SSIs during digestive and colorectal surgery, even when restricted to clean-contaminated wounds. However, the hospital stay length was not affected.