EP963 - Does Warm Humidification with Carbon Dioxide in Colorectal Surgery Reduce Surgical Site Infection? - A Systematic Review and Meta-Analysis

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Purpose/Background: Surgical site infections (SSI) are a common complication in open abdominal surgeries, particularly in open colorectal procedures, with incidence rates up to 20%. SSIs contribute to increased morbidity, mortality, healthcare costs, and extended hospital stays. Warm Humidified Carbon Dioxide Insufflation (WHCI), commonly used in laparoscopic surgery, is hypothesized to reduce SSIs and other postoperative complications by maintaining normothermia and minimizing peritoneal damage. This systematic review and meta-analysis aimed to investigate the effects of WHCI in open abdominal surgery on perioperative outcomes, including SSI, core temperature, length of stay (LOS), and anastomotic leak.

Methods/Interventions: A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases searched included PubMed, OVID Medline, Cochrane Central Register of Controlled Trials, CINAHL, and OVID Embase up to September 2023. Only randomized controlled trials (RCTs) evaluating WHCI in open abdominal surgery were included. The primary outcome was SSI, with secondary outcomes including core temperature, LOS, and anastomotic leak. Two authors independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk-of-bias tool (RoB-2). Meta-analysis was performed using RStudio, employing random-effect or fixed-effect models based on heterogeneity. Results were visualized with forest plots.

Results/Outcomes: Six RCTs were included in the meta-analysis, comprising a total of 336 patients for SSI analysis and 314 patients for core temperature and LOS analyses. The use of WHCI showed a non-significant trend towards reducing SSI rates (OR = 0.38, 95% CI [0.11, 1.30], p=0.12). Core body temperature at the end of the procedure demonstrated a tendency towards being warmer in the WHCI group (SMD = 1.13, 95% CI [-0.07, 2.33], p=0.06), although this was not statistically significant. No statistically significant differences were observed in LOS (SMD = 0.07, 95% CI [-0.11, 0.24], p=0.45) between the WHCI and control groups. Anastomotic leak data were limited and not suitable for meta-analysis. Overall, the included studies showed a low risk of bias, with single-blinding due to the nature of the intervention being the main limitation.

Conclusion/Discussion: While WHCI shows potential benefits in open colorectal surgery, including a trend towards reduced SSIs and maintenance of core temperature, these findings were not statistically significant. WHCI devices were overall found to be safe and not a hindrance to the operation. The lack of statistical significance may be due to the limited number of studies and relatively small sample sizes. Further large-scale clinical trials are required to establish the efficacy of WHCI on postoperative outcomes in open abdominal surgery, particularly in emergency settings. Future research should focus on standardizing outcome measures, including clear definitions of SSI, and investigating the potential benefits of WHCI in various types of open abdominal surgeries beyond colorectal procedures.