Antibiotic versus saline wound irrigation after appendectomy for prevention of incisional surgical site infection: a systematic review and meta-analysis of randomised controlled trials
In brief
Antibiotic wound irrigation cut infections about half in open appendectomy trials
Across eight trials, infections occurred in 40 of 994 patients given antibiotic irrigation, versus 89 of 1,013 given saline. The pooled result suggests antibiotic irrigation may reduce infections, but the evidence was low certainty, and the benefit was not statistically significant in the small group of lower-bias trials. No consistent regimen is established, so routine use remains uncertain.
- Journal
- The Journal of hospital infection (Q1)
- Published
- 5 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Mohamed Hajri, Tarak Dhaouadi, Lassad Gharbi, Zied Hadrich, Ahlem Hajri, Aziz Atallah, et al.
- PMID
- 42833497
- DOI
- 10.1016/j.jhin.2026.09.026
Why clinicians should know about it
- Picked for Surgery (paper of the day, 7 October 2026): Systematic review, antibiotic irrigation after appendectomy
Abstract
BACKGROUND: Incisional surgical site infection (SSI) remains a costly complication after appendectomy. Although saline wound irrigation is widely used, the added value of antibiotic irrigation remains uncertain, particularly in the context of antimicrobial stewardship. AIM: To evaluate whether intraoperative incisional wound irrigation with an antibiotic solution reduces incisional SSI compared with saline irrigation after open appendectomy. METHODS: We conducted a PRISMA 2020 systematic review and meta-analysis (PROSPERO-CRD420261323864) of randomised controlled trials comparing antibiotic solution versus normal saline wound irrigation during open appendectomy. PubMed/MEDLINE, EMBASE, Web of Science, Scopus, and the Cochrane Library were searched to February 28, 2026. The primary outcome was incisional SSI. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Subgroup analyses, meta-regression, publication bias assessment, GRADE assessment, and trial sequential analysis (TSA) were performed. FINDINGS: Eight trials involving 2007 participants were included. Incisional SSI occurred in 40/994 patients in the antibiotic-irrigation group and 89/1013 patients in the saline-irrigation group. Antibiotic irrigation was associated with a lower risk of incisional SSI (RR 0.48, 95% CI 0.32-0.71; P=0.0002), with low statistical heterogeneity (I2=7.5%). Subgroup and meta-regression analyses did not identify significant effect modification. The certainty of evidence was low because of risk of bias and indirectness. CONCLUSION: Low-certainty randomised evidence suggests that antibiotic-solution wound irrigation may reduce incisional SSI after open appendectomy. However, no reproducible regimen can currently be recommended, the benefit was not statistically significant in the small low-risk-of-bias subgroup, and high-quality trials are needed before routine implementation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.