Vascular Centre, Skane University Hospital, Malmö, Sweden.
Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
Br J Surg. 2019 Mar;106(4):310-318. doi: 10.1002/bjs.11100. Epub 2019 Feb 6.
Surgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery.
A study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full text by two of the authors independently. The selected articles were rated for bias according to the Cochrane risk-of-bias tool.
Among 1567 records generated by the search, seven RCTs were identified, including 1049 incisions. Meta-analysis showed a reduction in SSI with incisional NPWT (odds ratio (OR) 0·35, 95 per cent c.i. 0·24 to 0·50; P < 0·001). The heterogeneity between the included studies was low (I = 0 per cent). The quality of evidence was graded as moderate. Two studies had multiple domains in the Cochrane risk-of-bias tool rated as high risk of bias. A subgroup meta-analysis of three studies of lower limb revascularization procedures only (363 incisions) demonstrated a similar reduction in SSI (OR 0·37, 0·22 to 0·63; P < 0·001; I = 0 per cent).
Incisional NPWT after groin incisions for arterial surgery reduced the incidence of SSI compared with standard wound dressings. The risk of bias highlighted the need for a high-quality RCT with cost-effectiveness analysis.
腹股沟切口动脉手术后的手术部位感染（SSI）很常见，可能导致截肢或死亡。有研究表明，切口负压伤口治疗（NPWT）敷料可降低 SSI 的发生率。本系统评价和荟萃分析旨在评估腹股沟动脉手术后闭合性腹股沟切口 NPWT 对 SSI 发生率的影响。
本前瞻性 RCT 系统评价研究方案已在 PROSPERO（CRD42018090298）上发表，设定了明确的检索、纳入和排除标准。通过标题和摘要以及全文筛选由系统研究产生的记录，以确定其相关性。由两位作者独立对入选的文章进行偏倚评估。
通过检索共生成 1567 条记录，确定了 7 项 RCT，共纳入 1049 个切口。Meta 分析显示，NPWT 可降低 SSI 的发生率（比值比（OR）0.35，95%置信区间（CI）0.24 至 0.50；P<0.001）。纳入研究的异质性较低（I²=0%）。证据质量被评为中等。有两项研究在 Cochrane 偏倚风险工具的多个领域被评为高偏倚风险。仅对 3 项下肢血运重建手术研究（363 个切口）的亚组 Meta 分析显示，SSI 发生率降低相似（OR 0.37，0.22 至 0.63；P<0.001；I²=0%）。
与标准伤口敷料相比，动脉手术后腹股沟切口 NPWT 可降低 SSI 的发生率。偏倚风险突出了需要一项高质量的 RCT，并进行成本效益分析。
