Summary of findings 1. Fibrin glue instillation under skin flaps compared to no‐fibrin for breast and axillary surgery.
| Fibrin glue instillation under skin flaps compared to no‐fibrin for breast and axillary surgery | ||||||
| Patient or population: people with breast and axillary surgery Settings: Intervention: fibrin glue instillation under skin flaps Comparison: no‐fibrin | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| No‐fibrin | Fibrin glue instillation under skin flaps | |||||
| Incidence of postoperativeseroma RR Follow‐up: 4‐16 weeks | Study population | RR 1.02 (0.9 to 1.16) | 1252 (18 studies) | ⊕⊕⊝⊝ low | ||
| 281 per 1000 | 286 per 1000 (253 to 326) | |||||
| Moderate | ||||||
| 229 per 1000 | 234 per 1000 (206 to 266) | |||||
| Mean volume of seroma SMD Follow‐up: 4‐16 weeks | The mean volume of seroma in the intervention groups was 0.25 standard deviations lower (0.92 lower to 0.42 higher) | 731 (10 studies) | ⊕⊕⊝⊝ low1 | SMD ‐0.25 (‐0.92 to 0.42) | ||
| Total volume of drained seroma SMD Follow‐up: 4‐16 weeks | The mean total volume of drained seroma in the intervention groups was 0.75 standard deviations lower (1.24 to 0.26 lower) | 888 (13 studies) | ⊕⊕⊝⊝ low | SMD ‐0.75 (‐1.24 to ‐0.26) | ||
| Number of days for persistent drainage SMD Follow‐up: 4‐16 weeks | The mean number of days for persistent drainage in the intervention groups was 0.59 standard deviations lower (0.95 to 0.23 lower) | 861 (13 studies) | ⊕⊕⊝⊝ low | SMD ‐0.59 (‐0.95 to ‐0.23) | ||
| Surgical site infection RR Follow‐up: 4‐16 weeks | Study population | RR 1.05 (0.63 to 1.77) | 1009 (13 studies) | ⊕⊕⊝⊝ low | ||
| 48 per 1000 | 50 per 1000 (30 to 85) | |||||
| Moderate | ||||||
| 25 per 1000 | 26 per 1000 (16 to 44) | |||||
| Postoperativecomplications RR Follow‐up: 4‐16 weeks | Study population | RR 1.13 (0.63 to 2.04) | 981 (11 studies) | ⊕⊕⊝⊝ low | ||
| 39 per 1000 | 44 per 1000 (24 to 79) | |||||
| Moderate | ||||||
| 44 per 1000 | 50 per 1000 (28 to 90) | |||||
| Length of hospital stay SMD Follow‐up: 4‐16 weeks | The mean length of hospital stay in the intervention groups was 0.2 standard deviations lower (0.78 lower to 0.39 higher) | 364 (6 studies) | ⊕⊕⊝⊝ low | SMD ‐0.2 (‐0.78 to 0.39) | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; SMD: standardised mean difference. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 There was inadequate randomisation technique and absence of power calculations, blinding and intention‐to‐treat analysis.