Silver-containing dressing for surgical site infection in clean and clean-contaminated operations: a systematic review and meta-analysis of randomized controlled trials

Background: Silver-containing dressings for the prevention of surgical site infections (SSIs) remained controversial, and accumulating evidence was lacking, so a meta-analysis was conducted to systematically assess the effectiveness and safety of silver-containing dressings for clean and clean-contaminated surgical incisions. Methods: Pubmed, Embase, and the Cochrane Library were searched from the inception to February 2016 for randomized controlled trials (RCTs), which explored silver-containing dressings for the prevention of SSIs in clean and clean-contaminated operations. Relative risk (RR) with 95% confidence interval (CI) was pooled using random effects model. Predefined subgroup analyses, sensitivity analyses, and influence analyses were further undertaken. Results: Nine RCTs totaling 2196 patients (1141 in silver-containing group and 1055 in control group) were included. Silver-containing dressings did not effectively prevent the incidence of SSIs (9 RCTs; RR: 0.92; 95% CI: 0.66-1.29; I-2 = 40%), superficial SSIs (5 RCTs; RR: 0.67; 95% CI: 0.36-1.24; I-2 = 36%), and deep SSIs (5 RCTs; RR: 0.78; 95% CI: 0.41-1.49; I-2 = 0). Subgroup analyses, sensitivity analyses, and influence analyses confirmed the robustness of the pooled estimate. Conclusions: The current available evidence indicated that silver-containing dressing as compared with silver-free dressing was not associated with lower incidence of SSIs. Considering the quality of evidence ranking very low, further studies with higher quality should be warranted. (C) 2017 Elsevier Inc. All rights reserved.