Review Question

What are the benefits and risks of removing a dressing covering a closed surgical incision site within 48 hours or after 48 hours of surgery?

Type of Review

This is a summary of a Cochrane systematic review of four randomized clinical trials (RCTs).

Relevance for Nursing

Following the closure of surgical wounds, dressings provide a physical barrier against bacterial contamination until epithelialization of the skin occurs, usually 48 hours after surgery. Removal of dressings can be performed within 48 hours of surgery (early dressing removal) or after 48 hours (delayed dressing removal). There may be disadvantages to delaying the removal of dressings, as some may create a moist environment conducive to infection. This systematic review assesses the risks and benefits of early or late dressing removal for patients with surgical wounds.

Characteristics of the Evidence

Four RCTs comprising 317 patients were included: 147 received early dressing removal and 160 delayed dressing removal (10 were lost to follow-up). Each trial included patients who had undergone a variety of surgical procedures: one included abdominal, cervical, and thoracic surgeries; another included coronary artery bypass graft surgery; a third included correction of prominent ears; and the last did not specify surgery type. One trial used antibiotics prophylactically for a maximum of 24 hours after surgery, and the other three either did not use antibiotics or did not report on their use.

Primary outcomes were superficial or deep surgical site infection within 30 days of surgery, superficial or deep wound dehiscence within 30 days of surgery, and other serious adverse events within 30 days of surgery. Secondary outcomes included hospital length of stay and costs at maximal follow-up. One of the studies did not report on any of the outcomes, and therefore did not contribute any data to the review.

Results were pooled where possible. Three trials reported on superficial surgical site infection, and there was no statistically significant difference in the risk of surgical site infection between the early and delayed dressing-removal groups. There were no deep surgical site infections in the one trial that reported on this outcome.

There were no significant differences in the proportion of people who developed superficial wound dehiscence in the early or delayed dressing-removal groups, and no instances of deep wound dehiscence in either group.

Data from one trial showed a statistically significant difference in hospital length of stay in favor of early dressing removal. One study included total costs related to the procedure and hospitalization at maximal follow-up, with a significantly lower cost for the early dressing-removal group.

Best Practice Recommendations

There was no detrimental effect on outcomes from the early removal of dressings from surgical wounds. Furthermore, evidence from one trial indicated that early dressing removal may decrease hospital length of stay and reduce costs related to surgical procedures and hospitalization. As this review included data from only three small RCTs that were of low methodological quality, these results should be interpreted with caution.

Research Recommendations

Additional well-designed RCTs are required to further investigate the benefits and risks of early versus delayed dressing removal from clean and clean-contaminated surgical wounds.

Reference