Primary Versus Delayed Primary Incision Closure in Contaminated Abdominal Surgery: A Meta-Analysis

Abstract Background Debates still exist whether delayed primary incision closure (DPC) could bring more benefits to patients suffering contaminated abdominal surgery. So, we want to determine whether DPC has advantage over primary incision closure (PC) in contaminated abdominal surgery. Methods Embase, Medline, and the Cochrane Library databases were searched for eligible studies from January 1, 1980 to August 6, 2017. Bibliographies of potential eligibility were also retrieved. The primary outcome was the rate of surgical site infection (SSI) and the second outcome was length of hospital stay (LOS). A systematic review and meta-analysis of RCTs were performed. Results Twelve studies were included in the final quantitative synthesis. Of the 12 studies included, five were from third world countries (i.e., India and Pakistan), and all of these demonstrated an improvement in SSI rate with DPC. When the fixed-effect model used, compared with PC, SSI was significantly reduced in DPC with a risk ratio of 0.64 (0.51-0.79) ( P P  = 0.0004). Although the random-effect model was used, no significant difference in SSI between DPC and PC was observed with a risk ratio of 0.65 (0.38-1.12) ( P  = 0.12), and no significant difference in LOS between DPC and PC was found with a mean difference of 1.19 (−1.03 to 3.41) ( P  = 0.29). Conclusions DPC may be the preferable choice in contaminated abdominal surgeries, especially in patients with high risk of infection, and particularly in resource constrained environments. In addition, more high-quality studies with well design are needed to provide clear evidence.