全球阑尾切除术术后手术部位感染发生率：系统评价和荟萃分析。
Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis.
机构信息
Epidemiology and Biostatistics Unit, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Bruxelles, Belgium.
Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
出版信息
BMJ Open. 2020 Feb 18;10(2):e034266. doi: 10.1136/bmjopen-2019-034266.
BACKGROUND
Although surgical site infection (SSI) is one of the most studied healthcare-associated infections, the global burden of SSI after appendectomy remains unknown.
OBJECTIVE
We estimated the incidence of SSI after appendectomy at global and regional levels.
DESIGN
Systematic review and meta-analysis.
PARTICIPANTS
Appendectomy patients.
DATA SOURCES
EMBASE, PubMed and Web of Science were searched, with no language restrictions, to identify observational studies and clinical trials published between 1 January 2000 and 30 December 2018 and reporting on the incidence of SSI after appendectomy. A random-effect model meta-analysis served to obtain the pooled incidence of SSI after appendectomy.
RESULTS
In total, 226 studies (729 434 participants from 49 countries) were included in the meta-analysis. With regard to methodological quality, 59 (26.1%) studies had low risk of bias, 147 (65.0%) had moderate risk of bias and 20 (8.8%) had high risk of bias. We found an overall incidence of SSI of 7.0 per 100 appendectomies (95% prediction interval: 1.0-17.6), varying from 0 to 37.4 per 100 appendectomies. A subgroup analysis to identify sources of heterogeneity showed that the incidence varied from 5.8 in Europe to 12.6 per 100 appendectomies in Africa (p<0.0001). The incidence of SSI after appendectomy increased when the level of income decreased, from 6.2 in high-income countries to 11.1 per 100 appendectomies in low-income countries (p=0.015). Open appendectomy (11.0 per 100 surgical procedures) was found to have a higher incidence of SSI compared with laparoscopy (4.6 per 100 appendectomies) (p=0.0002).
CONCLUSION
This study suggests a high burden of SSI after appendectomy in some regions (especially Africa) and in low-income countries. Strategies are needed to implement and disseminate the WHO guidelines to decrease the burden of SSI after appendectomy in these regions.
PROSPERO REGISTRATION NUMBER
CRD42017075257.
背景
虽然手术部位感染（SSI）是研究最多的与医疗保健相关的感染之一，但阑尾切除术后 SSI 的全球负担仍不清楚。
目的
我们估计了全球和区域水平阑尾切除术后 SSI 的发生率。
设计
系统评价和荟萃分析。
参与者
阑尾切除术患者。
数据来源
EMBASE、PubMed 和 Web of Science 进行了检索，无语言限制，以确定 2000 年 1 月 1 日至 2018 年 12 月 30 日期间发表的报告阑尾切除术后 SSI 发生率的观察性研究和临床试验。采用随机效应模型荟萃分析获得阑尾切除术后 SSI 的汇总发生率。
结果
共纳入 226 项研究（来自 49 个国家的 729434 名参与者）进行荟萃分析。就方法学质量而言，59 项（26.1%）研究的偏倚风险较低，147 项（65.0%）研究的偏倚风险为中度，20 项（8.8%）研究的偏倚风险较高。我们发现总的 SSI 发生率为每 100 例阑尾切除术 7.0 例（95%预测区间：1.0-17.6），范围从每 100 例阑尾切除术 0 到 37.4 例。一项旨在确定异质性来源的亚组分析表明，发病率从欧洲的 5.8 例到非洲的 12.6 例每 100 例阑尾切除术（p<0.0001）不等。阑尾切除术后 SSI 的发生率随着收入水平的降低而增加，从高收入国家的每 100 例阑尾切除术 6.2 例增加到低收入国家的每 100 例阑尾切除术 11.1 例（p=0.015）。与腹腔镜相比，开放性阑尾切除术（每 100 例手术 11.0 例）的 SSI 发生率更高（每 100 例阑尾切除术 4.6 例）（p=0.0002）。
结论
本研究表明，在一些地区（尤其是非洲）和低收入国家，阑尾切除术后 SSI 的负担较高。需要实施和传播世卫组织指南，以减少这些地区阑尾切除术后 SSI 的负担。
PROSPERO 注册号：CRD42017075257。
Zotero 插件