Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement: Special Issue: Trauma and Emergency: Beyond Damage Control Surgery

Gearóid Geehan, Itoro Edelduok, Magda Bucholc, Angus Watson, Zsolt Bodnar , Alison Johnston, Michael Sugrue

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)
88 Downloads (Pure)


Background: Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. Methods: An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included “emergency surgery”, “laparotomy”, “surgical site infection”, “midline incision” and “wound bundle”. Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. Results: This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39–1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57–1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. Conclusions: This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle’s ability to potentially improve outcome after emergency laparotomy.
Original languageEnglish
Article number138
Pages (from-to)1-14
Number of pages14
Issue number2
Publication statusPublished (in print/issue) - 11 Feb 2021

Bibliographical note

Funding Information:
Funding: This project was supported by the European Union’s INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB) and Donegal Clinical and Research Academy, Professor William Campbell Nobel Laureate Scholarship.

Publisher Copyright:
© 2021 by the authors.

Copyright 2021 Elsevier B.V., All rights reserved.


  • Emergency surgery
  • laparotomy
  • surgical site infection
  • midline incision
  • wound bundle
  • Wound bundle
  • Midline incision
  • Surgical site infection
  • Laparotomy


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