Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, and Department of Clinical Sciences, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK.
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Br J Surg. 2017 Jan;104(2):e134-e144. doi: 10.1002/bjs.10443. Epub 2017 Jan 17.
Despite several randomized trials, systematic reviews and meta-analyses that have demonstrated the effectiveness of antimicrobial (triclosan-coated or -impregnated) sutures (TCS), the clinical and economic impact of using these sutures compared with conventional non-antimicrobial-coated absorbable sutures (NCS) remains poorly documented.
An independent systematic review and meta-analysis of all published evidence from January 2005 to September 2016 comparing TCS with NCS was conducted. Surgical-site infection (SSI) was the primary outcome. The results of the meta-analysis were used in a decision-tree deterministic and stochastic cost model, using the National Health Service (NHS England)-based cost of inpatient admissions for infections and differential costs of TCS versus NCS.
Thirty-four studies were included in the final assessment from an initial 163 identified citations; 20 of 34 studies were randomized, and 17 of 34 reported blinding of physicians and assessors. Using a random-effects model, the odds ratio for SSI in the TCS compared with NCS control groups was statistically significant (odds ratio 0·61, 95 per cent c.i. 0·52 to 0·73; P < 0·001). There was significant heterogeneity (I = 49 per cent). Using random-effects event estimates of SSI for TCS and NCS for each individual wound type, the mean savings per surgical procedure from using antimicrobial sutures were significant: £91·25 (90 per cent c.i. 49·62 to 142·76) (€105·09 (57·15 to 164·41); exchange rate 15 November 2016) across all wound types.
The reviewed literature suggested that antimicrobial sutures may result in significant savings across various surgical wound types.
尽管有几项随机试验、系统评价和荟萃分析已经证明了抗菌（三氯生涂层或浸渍）缝线（TCS）的有效性，但与传统的非抗菌涂层可吸收缝线（NCS）相比，使用这些缝线的临床和经济影响仍记录甚少。
对 2005 年 1 月至 2016 年 9 月期间发表的所有比较 TCS 与 NCS 的证据进行了独立的系统评价和荟萃分析。手术部位感染（SSI）是主要结局。荟萃分析的结果被用于决策树确定性和随机成本模型，使用了基于英国国家医疗服务体系（NHS England）的感染住院费用和 TCS 与 NCS 的差异成本。
从最初确定的 163 篇引文中有 34 篇研究最终被纳入评估；34 篇研究中有 20 篇为随机对照试验，34 篇中有 17 篇报告了医生和评估者的盲法。使用随机效应模型，TCS 组与 NCS 对照组的 SSI 比值具有统计学意义（比值 0.61，95%置信区间 0.52 至 0.73；P<0.001）。存在显著的异质性（I=49%）。对于 TCS 和 NCS 的每一种单独的伤口类型，使用抗菌缝线的每例手术的平均节省费用是显著的：£91.25（90%置信区间 49.62 至 142.76）（€105.09（57.15 至 164.41）；2016 年 11 月 15 日汇率）在所有伤口类型中均有显著节省。
回顾的文献表明，抗菌缝线可能在各种手术伤口类型中带来显著的节省。
