South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK. Electronic address: https://twitter.com/VascResearchNet.
University of Bristol, Bristol, UK.
Eur J Vasc Endovasc Surg. 2021 Apr;61(4):636-646. doi: 10.1016/j.ejvs.2020.11.053. Epub 2021 Jan 7.
Groin incision surgical site infections (SSIs) following arterial surgery are common and are a source of considerable morbidity. This review evaluates interventions and adjuncts delivered immediately before, during, or after skin closure, to prevent SSIs in patients undergoing arterial interventions involving a groin incision.
MEDLINE, EMBASE, and CENTRAL databases were searched.
This review was undertaken according to established international reporting guidelines and was registered prospectively with the International prospective register of systematic reviews (CRD42020185170). The MEDLINE, EMBASE, and CENTRAL databases were searched using pre-defined search terms without date restriction. Randomised controlled trials (RCTs) and observational studies recruiting patients with non-infected groin incisions for arterial exposure were included; SSI rates and other outcomes were captured. Interventions reported in two or more studies were subjected to meta-analysis.
The search identified 1 532 articles. Seventeen RCTs and seven observational studies, reporting on 3 747 patients undergoing 4 130 groin incisions were included. A total of seven interventions and nine outcomes were reported upon. Prophylactic closed incision negative pressure wound therapy (ciNPWT) reduced groin SSIs compared with standard dressings (odds ratio [OR] 0.34, 95% CI 0.23 - 0.51; p < .001, GRADE strength of evidence: moderate). Local antibiotics did not reduce groin SSIs (OR 0.60 95% CI 0.30 - 1.21 p = .15, GRADE strength: low). Subcuticular sutures (vs. transdermal sutures or clips) reduced groin SSI rates (OR 0.33, 95% CI 0.17 - 0.65, p = .001, GRADE strength: low). Wound drains, platelet rich plasma, fibrin glue, and silver alginate dressings did not show any significant effect on SSI rates.
There is evidence that ciNPWT and subcuticular sutures reduce groin SSI in patients undergoing arterial vascular interventions involving a groin incision. Local antibiotics did not reduce groin wound SSI, although the strength of this evidence is lower. No other interventions demonstrated a significant effect.
股部切口手术后发生的切口感染（SSI）在动脉手术后很常见，是导致大量发病率的原因之一。本综述评估了在皮肤闭合前、中或后立即给予的干预措施和辅助措施，以预防接受股部切口动脉介入的患者发生 SSI。
MEDLINE、EMBASE 和 CENTRAL 数据库进行了检索。
本综述根据既定的国际报告指南进行，并前瞻性地在国际系统评价注册库（CRD42020185170）进行了注册。使用预定义的搜索词对 MEDLINE、EMBASE 和 CENTRAL 数据库进行了无日期限制的搜索。纳入了招募非感染性股部切口用于动脉暴露的患者的随机对照试验（RCT）和观察性研究；记录 SSI 发生率和其他结局。对两项或更多研究报告的干预措施进行了荟萃分析。
搜索共确定了 1532 篇文章。纳入了 17 项 RCT 和 7 项观察性研究，共报告了 3747 名接受 4130 次股部切口的患者。共报告了 7 项干预措施和 9 项结局。预防性闭合切口负压伤口治疗（ciNPWT）与标准敷料相比，降低了股部 SSI 的发生率（比值比[OR] 0.34，95%置信区间[CI] 0.23-0.51；p <.001，GRADE 证据强度：中等）。局部抗生素不能降低股部 SSI 的发生率（OR 0.60，95%CI 0.30-1.21，p =.15，GRADE 证据强度：低）。皮内缝合（与皮外缝合或皮夹相比）降低了股部 SSI 的发生率（OR 0.33，95%CI 0.17-0.65，p =.001，GRADE 证据强度：低）。伤口引流、富含血小板的血浆、纤维蛋白胶和银藻酸盐敷料对 SSI 发生率没有显示出任何显著影响。
有证据表明，ciNPWT 和皮内缝合可降低接受股部切口动脉血管介入的患者的股部 SSI。局部抗生素并不能降低股部切口的 SSI，但该证据的强度较低。没有其他干预措施显示出显著效果。
