Summary of findings 9. Summary of findings (postoperative wound infection).
| HARM | |||||||
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Patient or population: adults undergoing any type of surgery under general anaesthesia Interventions: antiemetic drugs (monoprophylaxis and combination prophylaxis)* Comparator (reference): placebo (or no treatment) Outcome: wound infection within 7 days postoperatively Setting: inpatient and outpatient | |||||||
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Total studies: 32 RCTs Total participants: 4369 Number of treatments: 10 Geometry of the network** |
Relative effect*** (95% CI) |
Anticipated absolute effect **** (95% CI) | Certainty of evidence |
Ranking ***** (P score) |
Interpretation of findings | ||
| Without intervention | With intervention | Difference | |||||
| 5‐HT3 receptor antagonists | |||||||
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Dolasetron (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Granisetron (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Ondansetron (no direct evidence, indirect evidence only) |
1.28 (0.01 to 115.24) |
4 per 10001 | 5 per 1000 | 1 more per 1000 (4 fewer to 457 more) |
⊕⊖⊖⊖ Very low Due to imprecision, incoherence2 |
Rank 9 (0.3974) Rank 6 of 6 single drugs |
We are uncertain whether ondansetron increases wound infection |
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Palonosetron (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Ramosetron (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Tropisetron (1 RCT; 156 participants) |
0.42 (0.04 to 4.55) |
4 per 10001 | 2 per 1000 | 2 fewer per 1000 (4 fewer to 14 more) |
⊕⊕⊖⊖ Low Due to imprecision2 |
Rank 2 (0.6171) Rank 2 of 6 single drugs |
Tropisetron may reduce wound infection |
| D2 receptor antagonists | |||||||
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Amisulpride (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Droperidol (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Haloperidol (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Metoclopramide (1 RCT; 104 participants) |
0.96 (0.04 to 21.33) |
4 per 10001 | 4 per 1000 | 0 fewer/more per 1000 (4 fewer to 81 more) |
⊕⊖⊖⊖ Very low Due to study limitations, imprecision3 |
Rank 5 (0.4360) Rank 3 of 6 single drugs |
We are uncertain whether metoclopramide has little or no effect on wound infection |
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Perphenazine (0 RCT; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
| NK1 receptor antagonists | |||||||
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Aprepitant (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Casopitant (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Fosaprepitant (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Rolapitant (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
| Corticosteroids | |||||||
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Dexamethasone (24 RCTs; 3199 participants) |
0.91 (0.45 to 1.87) |
4 per 10001 | 4 per 1000 | 0 fewer/more per 1000 (2 fewer to 3 more) |
⊕⊖⊖⊖ Very low Due to study limitations, imprecision3 |
Rank 8 (0.4272) Rank 5 of 6 single drugs |
We are uncertain whether dexamethasone has little or no effect on wound infection |
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Methylprednisolone (1 RCT; 40 participants) |
1.00 (0.02 to 48.03) |
4 per 10001 | 4 per 1000 | 0 fewer/more per 1000 (4 fewer to 188 more) |
⊕⊖⊖⊖ Very low Due to study limitations, imprecision3,4 |
Rank 5 (0.4360) Rank 3 of 6 single drugs |
We are uncertain whether methylprednisolone has little or no effect on wound infection |
| Antihistamines | |||||||
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Dimenhydrinate (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Meclizine (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
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Promethazine (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
| Anticholinergics | |||||||
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Scopolamine (0 RCTs; 0 participants) |
NA | NA | NA | NA | NA | NA | No studies were found that looked at wound infection |
| Comparator | |||||||
| Placebo | Reference comparator | Not estimable | Not estimable | Not estimable | Reference comparator |
Rank 10 (0.3885) |
Reference comparator |
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NMA‐SoF table definitions: * Certainty of evidence was assessed only for single antiemetic drugs of direct interest. ** Geometry of the network is presented in Figure 22 (netgraph). *** Network estimates are reported as risk ratio (RR) with confidence interval (CI). **** Anticipated absolute effects. The anticipated absolute effect compares two risks by calculating the difference between risk of the intervention group and risk of the control group. ***** Ranking of treatments includes all single drugs and combinations of drugs and is based on the P score (a value on a continuous 0 to 1 scale), which measures the extent of certainty that a treatment is better than another treatment, averaged over all competing treatments (Supplementary Files‐8‐wound infection). Larger P scores indicate better treatments. In addition, the rank of the treatment out of all single drugs is indicated. | |||||||
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GRADE working group grades of evidence (or certainty of the evidence). High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of effect. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect. | |||||||
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Explanatory footnotes: 1 Baseline risks (assumed control risk) are based on the total events of all placebo groups included in the outcome wound infection. The general incidence of wound infection after surgery with placebo is about 0.44%. 2 Very serious concerns for imprecision and serious concerns for incoherence. 3 Serious concerns for study limitations and very serious concerns for imprecision. 4 Poorly connected to the network. Only direct evidence available. | |||||||