Preoperative and postoperative recommendations to surgical wound care interventions: A systematic meta-review of Cochrane reviews

Brigid M Gillespie; Rachel M Walker; Elizabeth McInnes; Zena Moore; Anne M Eskes; Tom O'Connor; Emma Harbeck; Codi White; Ian A Scott; Hester Vermeulen; Wendy Chaboyer

doi:10.1016/j.ijnurstu.2019.103486

Preoperative and postoperative recommendations to surgical wound care interventions: A systematic meta-review of Cochrane reviews

Int J Nurs Stud. 2020 Feb:102:103486. doi: 10.1016/j.ijnurstu.2019.103486. Epub 2019 Nov 22.

Authors

Affiliations

¹ School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Australia; Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia; School of Nursing and Midwifery, Royal College of Surgeons, Dublin, Ireland. Electronic address: b.gillespie@griffith.edu.au.
² School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Australia; Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia. Electronic address: https://twitter.com/RachelMWalker.
³ Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Australia.
⁴ School of Nursing and Midwifery, Royal College of Surgeons, Dublin, Ireland; Skin Wounds and Trauma Research Centre, Royal College of Surgeons, United Kingdom; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Lida Institute, Shanghai, China. Electronic address: https://twitter.com/ZenaMoore5.
⁵ Department of Surgery, UMC and University of Amsterdam, The Netherlands. Electronic address: https://twitter.com/Anne_Eskes.
⁶ School of Nursing and Midwifery, Royal College of Surgeons, Dublin, Ireland; Skin Wounds and Trauma Research Centre, Royal College of Surgeons, United Kingdom; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Lida Institute, Shanghai, China. Electronic address: https://twitter.com/tocon.
⁷ School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Australia.
⁸ Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia.
⁹ IQ Healthcare, Radboud Institute of Health Sciences, Scientific Center for Quality of Healthcare, The Netherlands. Electronic address: https://twitter.com/hvermeulen67.

PMID: 31810020
DOI: 10.1016/j.ijnurstu.2019.103486

Abstract

Background: The increasing numbers of surgeries involving high risk, multi-morbid patients, coupled with inconsistencies in the practice of perioperative surgical wound care, increases patients' risk of surgical site infection and other wound complications.

Objectives: To synthesise and evaluate the recommendations for nursing practice and research from published systematic reviews in the Cochrane Library on nurse-led preoperative prophylaxis and postoperative surgical wound care interventions used or initiated by nurses.

Design: Meta-review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources: The Cochrane Library database.

Review methods: All Cochrane Systematic Reviews were eligible. Two reviewers independently selected the reviews and extracted data. One reviewer appraised the methodological quality of the included reviews using A MeaSurement Tool to Assess Systematic Reviews 2 checklist. A second reviewer independently verified these appraisals. The review protocol was registered with the Prospective Register of Systematic Reviews.

Results: Twenty-two Cochrane reviews met the inclusion criteria. Of these, 11 reviews focused on preoperative interventions to prevent infection, while 12 focused on postoperative interventions (one review assessed both pre-postoperative interventions). Across all reviews, 14 (63.6%) made at least one recommendation to undertake a specific practice, while two reviews (9.1%) made at least one specific recommendation not to undertake a practice. In relation to recommendations for further research, insufficient sample size was the most predominant methodological issue (12/22) identified across reviews.

Conclusions: The limited number of recommendations for pre-and-postoperative interventions reflects the paucity of high-quality evidence, suggesting a need for rigorous trials to address these evidence gaps in fundamentals of nursing care.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Humans
Postoperative Care*
Preoperative Care*
Surgical Wound Infection / nursing
Surgical Wound Infection / prevention & control
Surgical Wound*