Protocol for a systematic review and network meta-analysis of the use of prophylactic antibiotics in hand trauma surgery

Background: The use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery.

Methods and analysis: The databases EMBASE, MEDLINE, CINAHL and CENTRAL, metaRegister of controlled trials, clinicaltrials.gov and the WHO International Clinical Trials Registry Platform will be searched for published and unpublished studies which will then be screened by two persons independently to identify eligible studies.

This systematic review will include both randomised and non-randomised prospective comparative studies in participants with hand and/or wrist injuries requiring surgery. The network meta-analysis will compare the use of different prophylactic antibiotics against each other, placebo and/or no antibiotics on the development of SSI within 30 days of surgery (or 90 days if there is an implanted device).

The Cochrane Risk of Bias tool 2 will be used to assess the risk of methodological bias in randomised controlled trials and the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool will be used to assess the risk of bias in non-randomised studies. The ROB-MEN tool will be used to evaluate the risk of bias due to missing evidence in network meta-analysis.

A random effects network meta-analysis will be conducted along with subgroup analyses looking at antibiotic timing, operation type and injury type. Sensitivity analyses including only low risk of bias studies and the study location will be conducted and the confidence in the results will be assessed using Confidence in Network Meta‐Analysis (CINEMA).

Discussion: This systematic review and network meta-analysis aims to provide an up to date synthesis of the studies assessing the use of antibiotics following hand and wrist trauma to enable evidence-based peri-operative prescribing.