EPD514 - Plastic Wound Protector for Surgical Site Infection Reduction in Open Colorectal Surgery: A Systematic Review and Meta-analysis

Monday, May 11, 2026

4:52 PM - 4:57 PM ET

ePoster of Distinction Presenter(s)

Ilana Grosman Setton, MD

General Surgical Resident
Cleveland Clinic Florida
Cleveland Clinic Florida
Weston, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

PS

Paulo Eduardo Souza Castelo Branco, n/a

Medical Student
Faculdade de Minas, FAMINAS BH
Belo Horizonte, Minas Gerais, Brazil

Disclosure information not submitted.
TT

Tauana Terra Cordeiro de Oliveira, n/a

Medical student
Federal University of São João del-Rei
Divinópolis, Minas Gerais, Brazil

Disclosure information not submitted.
LS

Lia Simonetti Gomes NIcolau, MD

Colorectal surgeon
Santa Casa de Misericórdia de Fortaleza
Jundiaí, Sao Paulo, Brazil

Disclosure information not submitted.
NS

Nathan Joseph Silva Godinho, n/a

Medical Doctor
Universidade Federal de Minas Gerais
Belo Horizonte, Minas Gerais, Brazil

Disclosure information not submitted.
Nir Horesh, MD

Resident Physician
Cleveland Clinic Florida
Tel Aviv University
Weston, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
GD

Giovanna Dasilva, MD

Staff Colorectal Surgeon
Cleveland Clinic Florida
Cleveland Clinic Florida
Weston, Florida, United States

Disclosure information not submitted.

Senior Author(s)

Steven D. Wexner, MD, PhD (Hon)

Surgeon
Cleveland Clinic Florida
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
Weston, Florida, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Ilana Grosman Setton, MD: This individual has no financial relationships with ineligible companies.

Nir Horesh, MD: This individual has no financial relationships with ineligible companies.

Purpose/Background: Surgical site infection (SSI) is one of the most common complications of colorectal surgery (CRS), with an incidence that can be greater than 25%. SSIs directly impact surgical outcomes, including increasing the length of stay, cost of hospitalization, and mortality. One measure that has been demonstrated to reduce the risk of SSI is the use of a wound protector, which creates a physical barrier between the abdominal wall and other structures, isolating the wound edges from possible contamination. We performed a meta-analysis to evaluate whether the use of wound protectors in open colorectal surgery reduces the risk of SSIs.

Methods/Interventions: A systematic search was conducted in PubMed, Embase, Scopus, and Cochrane databases for studies involving patients undergoing open CRS with or without wound protectors. The incidence of SSI was our primary outcome of interest. The specific type of SSI was our secondary outcome. Statistical analysis was performed using the Review Manager 5.4 software, and heterogeneity was verified using I2 statistics, with quality assessment and risk of bias evaluation conducted following Cochrane guidelines

Results/Outcomes: Our initial search strategy retrieved 251 articles, 37 from PubMed, 88 from Embase, 35 from Cochrane, and 91 from Scopus. We excluded 113 duplicate articles, and 138 articles were screened by title and abstract. Of these, 122 articles were excluded because they did not answer our PICOT question, leaving 16 articles for a full-text review. Finally, only nine articles were included in this review; of these, seven were randomized clinical trials, and two were observational studies. In total, 3,267 patients underwent elective or emergency open CRS in the included studies, 61% were male. Of these, 1,476 were assigned to the intervention group, in which wound protectors were used during the open procedures, while 1,791 patients were assigned to the control group (non-wound protector group). The dual ring wound protector is the most used device in the studies, and the incidence of superficial incisional SSI is the outcome most evaluated. Patients undergoing open CRS showed a statistically significant 59% decrease in the incidence of all SSI when using wound protectors compared to non-wound protectors (RR 0.41; 95% CI 0.30-0.56; p< 0.001). In the group using a wound protector in open CRS, a decrease in the incidence of superficial incisional SSI (RR 0.50; 95% CI 0.30-0.81; p = 0.005), and deep incisional SSI (RR 0.51; 95% CI 0.20-1.26; p = 0.14) were observed, but the incidence of organ and space SSI (RR 0.98; 95% CI 0.47-2.06; p = 0.96) was not significant.

Conclusion/Discussion: This study demonstrates that the use of a wound protector during open CRS reduces the incidence of SSIs and incisional SSIs, but does not reduce the rates of organ-space SSIs. Our data support the use of wound protector devices in open CRS to prevent infections at incision sites, as some medical societies and the WHO have already recommended. The use of a wound protector directly influences surgical outcomes, avoiding longer hospital stays, reducing costs, and preventing mortality that SSI could potentially trigger.