Evidence map›Paper›PMID 36418793›Full record

ArticleHernia : the journal of hernias and abdominal wall surgery2023

Stopping prehospital chlorhexidine skin wash does not increase wound morbidity after incisional hernia repair: results of a 4-year quality improvement initiative.

B T Miller, S Phillips, B K Poulose, C C Petro, L R A Beffa, M J Rosen, D M Krpata, A S Prabhu

Abstract read
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In one paragraph

Article in Hernia : the journal of hernias and abdominal wall surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 3 pooled it
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 3 syntheses or guidelines pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Drain placement in retromuscular ventral hernia repair: a systematic review and meta-analysis.Hernia : the journal of hernias and abdominal wall surgery · 2023
    Pooled it
  3. Recall bias in pain scores evaluating abdominal wall and groin pain surgery.Hernia : the journal of hernias and abdominal wall surgery · 2023
    Pooled it
  4. Article
  5. Comment to "Psychological disorders in patients with chronic postoperative inguinal pain".Hernia : the journal of hernias and abdominal wall surgery · 2023
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

B T MillerDepartment of Surgery, Cleveland Clinic Center for Abdominal Core Health Cleveland Clinic Foundation, Cleveland, OH, USA. millerb35@ccf.org.ORCID 0000-0002-2745-7794
S PhillipsBiostatistics Department, Vanderbilt University Medical Center, Nashville, TN, USA.
B K PouloseDepartment of Surgery, Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
C C PetroDepartment of Surgery, Cleveland Clinic Center for Abdominal Core Health Cleveland Clinic Foundation, Cleveland, OH, USA.
L R A BeffaDepartment of Surgery, Cleveland Clinic Center for Abdominal Core Health Cleveland Clinic Foundation, Cleveland, OH, USA.
M J RosenDepartment of Surgery, Cleveland Clinic Center for Abdominal Core Health Cleveland Clinic Foundation, Cleveland, OH, USA.
D M KrpataDepartment of Surgery, Cleveland Clinic Center for Abdominal Core Health Cleveland Clinic Foundation, Cleveland, OH, USA.
A S PrabhuDepartment of Surgery, Cleveland Clinic Center for Abdominal Core Health Cleveland Clinic Foundation, Cleveland, OH, USA.
Cleveland Clinic · USThe Ohio State University Wexner Medical Center · USVanderbilt University Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPrehospital chlorhexidine gluconate (CHG) skin washes are used to prevent wound complications, but little evidence supports this practice in hernia surgery. A propensity-matched retrospective review published by our group in 2016 found that prehospital CHG was associated with an increased risk of surgical site occurrences (SSO) and surgical site infections (SSI) after ventral hernia repair. Prehospital CHG was, therefore, abandoned by three of five surgeons at the Cleveland Clinic Foundation (CCF) by April 2017. We aimed to determine if discontinuation of prehospital CHG affected wound morbidity rates after incisional hernia repair.

methodsThe Abdominal Core Health Quality Collaborative was queried for all patients who underwent open, clean incisional hernia repairs with 30-day follow-up from 2014 to 2019. Using an interrupted time series (ITS) analysis model adjusted for group and mean propensity score, wound morbidity before and after April 1, 2017 (start of Q2) was compared between three groups: CCF surgeons who abandoned prehospital CHG (Group 1), CCF surgeons who continued using prehospital CHG (Group 2), and non-CCF surgeons using prehospital CHG (Group 3). Outcomes included rates of SSOs, SSIs, and surgical site occurrences requiring procedural intervention (SSOPI) at 30 days.

resultsIn total, 4276 patients were included in the analysis (Group 1: 339 before Q2 vs 673 after Q2; Group 2: 211 before Q2 vs 175 after Q2; Group 3: 1312 before Q2 vs 1566 after Q2). Rates of SSO, SSIs, and SSOPIs at 30 days were similar across all three groups before and after prehospital CHG discontinuation.

conclusionStopping prehospital CHG wash did not result in increased wound morbidity after open, clean, incisional hernia repair. We have abandoned CHG use in this context.

Indexed as

Emergency Medical ServicesHernia, VentralIncisional HerniaChlorhexidineHerniorrhaphyHumansMorbidityQuality ImprovementRetrospective StudiesSurgical MeshSurgical Wound InfectionChlorhexidinechlorhexidine gluconateAbdominal Core Health Quality CollaborativeInterrupted times series analysisPrehospital chlorhexidine gluconateVentral hernia repair

Identifiers

PMID36418793
OpenAlexW4309915257

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.