Immediate Air Exposure vs Dressings Following Primary Closure of Clean and Clean-contaminated Surgical Wounds: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Introduction. It is unknown whether dressings reduce the risk of SSI after clean and clean-contaminated surgery. Objective. This meta-analysis was conducted to assess the outcomes of immediate air exposure of surgical sites after primary closure. Materials and Methods. A systematic search of Embase, PubMed, and Web of Science from the time of database establishment through October 2021 was performed. The SSI incidence and other surgical wound-associated events were extracted and their effect sizes calculated. Results. Six RCTs with a total of 1243 surgery cases (1228 non-contaminated, 15 contaminated) were included. SSI incidence of 11% and 11.1% was observed for immediate air exposure and dressings, respectively, when pooled irrespective of surgery type (RR, 0.95; 95% CI, 0.68–1.33 [P =.76]). Subgroup analysis showed similar SSI incidence between air exposure and dressings following clean (P =.39) and clean-contaminated surgery (P =.64). Neither gauze dressings (P =.65), film dressings (P =.07), nor tissue glue-as-a-dressing (P =.94) use resulted in significantly lower SSI incidence than air exposure. Conclusions. This meta-analysis shows that dressings (gauze dressings, film dressings, and tissue glue-as-a-dressing) do not outperform immediate air exposure in terms of SSI occurrence following primary closure of clean and clean-contaminated surgical wounds.