闭合切口负压治疗与手术部位感染减少相关：一项荟萃分析。
Closed Incision Negative-Pressure Therapy Is Associated with Decreased Surgical-Site Infections: A Meta-Analysis.
作者信息
Semsarzadeh Nina N, Tadisina Kashyap K, Maddox John, Chopra Karan, Singh Devinder P
机构信息
Bethesda and Baltimore, Md.; and Chicago, Ill. From the Division of Plastic Surgery, University of Maryland School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; the Department of General Surgery, Walter Reed National Military Medical Center at Bethesda; and the University of Illinois at Chicago College of Medicine.
出版信息
Plast Reconstr Surg. 2015 Sep;136(3):592-602. doi: 10.1097/PRS.0000000000001519.
BACKGROUND
Negative-pressure therapy has recently been used over closed incisions to decrease surgical-site occurrences, including infection and dehiscence. A meta-analysis was performed to evaluate the effectiveness of closed incision negative-pressure therapy in lowering the incidence of surgical-site infections compared with standard dressings.
METHODS
A literature search was conducted to find publications comparing closed incision negative-pressure therapy to standard incisional care. A fixed-effects model was used to assess between-study and between-incision location subgroup heterogeneity and effect size. Funnel plots were used to assess publication bias.
RESULTS
The overall weighted average rates of surgical-site infection in the closed incision negative-pressure therapy and control groups were 6.61 percent and 9.36 percent, respectively. This reflects a relative reduction in surgical site infection rate of 29.4 percent. A decreased likelihood of surgical-site infection was evident in the closed incision negative-pressure therapy group compared with the control group across all studies, and across all four incision location subgroups. Across all studies, odds of surgical-site infections decreased 0.564 (p < 0.00001). After excluding groin incision studies because of heterogeneity following sensitivity analysis, the odds of surgical-site infection decrease was still 0.496 (p < 0.00001). In addition, overall rates of dehiscence in closed incision negative-pressure therapy and control groups were 5.32 percent and 10.68 percent, respectively.
CONCLUSIONS
The results of this meta-analysis suggest that closed incision negative-pressure therapy is a potentially effective method for reducing surgical-site infections. It also appears that closed incision negative-pressure therapy may be associated with a decreased incidence of dehiscence, but the published data available were too heterogeneous to perform meta-analysis.
背景
负压疗法最近已用于闭合切口，以减少手术部位的并发症，包括感染和切口裂开。进行了一项荟萃分析，以评估与标准敷料相比，闭合切口负压疗法在降低手术部位感染发生率方面的有效性。
方法
进行文献检索，以查找比较闭合切口负压疗法与标准切口护理的出版物。使用固定效应模型评估研究间和切口位置亚组间的异质性及效应大小。采用漏斗图评估发表偏倚。
结果
闭合切口负压疗法组和对照组手术部位感染的总体加权平均发生率分别为6.61%和9.36%。这反映出手术部位感染率相对降低了29.4%。在所有研究以及所有四个切口位置亚组中，与对照组相比，闭合切口负压疗法组手术部位感染的可能性明显降低。在所有研究中，手术部位感染的比值比下降了0.564（p < 0.00001）。在敏感性分析后，由于腹股沟切口研究存在异质性而将其排除，手术部位感染的比值比仍下降了0.496（p < 0.00001）。此外，闭合切口负压疗法组和对照组切口裂开的总体发生率分别为5.32%和10.68%。
结论
这项荟萃分析的结果表明，闭合切口负压疗法是一种减少手术部位感染的潜在有效方法。闭合切口负压疗法似乎也可能与切口裂开发生率的降低有关，但现有的已发表数据异质性太大，无法进行荟萃分析。
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