Department of Operating Room, Yantaishan Hospital, Yantai City, Yantai, Shandong, China.
Department of Anesthesiology, Jinling Hospital, Nanjing, Jiangsu, China.
Ann R Coll Surg Engl. 2021 Mar;103(3):145-150. doi: 10.1308/rcsann.2020.7021.
The relation between type of ventilation used in the operating theatre and surgical site infection has drawn considerable attention. It has been reported that there is a possible relationship between the type of ventilation used in the operation theatre and surgical site infection. This meta-analysis was performed to evaluate this relationship.
Through a systematic literature search up to May 2020, 14 studies describing 590,121 operations, 328,183 were performed under laminar airflow ventilation and 2,611,938 were performed under conventional ventilation. Studies were identified that reported relationships between type of ventilation with its different categories and surgical site infection (10 studies were related to surgical site infection in total hip replacement, 7 in total knee arthroplasties and 3 in different abdominal and open vascular surgery). Odds ratios with 95% confidence intervals were calculated comparing surgical site infection prevalence and type of theatre ventilation using the dichotomous method with a random or fixed-effect model.
No significant difference was found between surgery performed under laminar airflow ventilation and conventional ventilation in total hip replacement (OR 1.23; 95% CI 0.97-1.56, = 0.09), total knee arthroplasties (OR 1.14; 95% CI 0.62-2.09, = 0.67) or different abdominal and open vascular surgery (OR 0.75; 95% CI 0.43-1.33, = 0.33). The impact of the type of theatre ventilation may have no influence on surgical site infection as a tool for decreasing its occurrence.
Based on this meta-analysis, operating under laminar airflow or conventional ventilation may have no independent relationship with the risk of surgical site infection. This relationship forces us not to recommend the use of laminar airflow ventilation since it has a much higher cost compared with conventional ventilation.
手术室中使用的通风类型与手术部位感染之间的关系引起了相当大的关注。据报道，手术室中使用的通风类型与手术部位感染之间可能存在一定的关系。进行这项荟萃分析是为了评估这种关系。
通过系统的文献搜索，截至 2020 年 5 月，共有 14 项研究描述了 590121 例手术，其中 328183 例在层流通风下进行，2611938 例在常规通风下进行。确定了 10 项研究与全髋关节置换术的手术部位感染有关，7 项研究与全膝关节置换术的手术部位感染有关，3 项研究与不同的腹部和开放性血管手术的手术部位感染有关的研究，报告了通风类型与其不同分类之间的关系。使用二项式方法和随机或固定效应模型，计算比较手术部位感染发生率和手术室通风类型的比值比及其 95%置信区间。
在全髋关节置换术（OR 1.23；95%CI 0.97-1.56， = 0.09）、全膝关节置换术（OR 1.14；95%CI 0.62-2.09， = 0.67）或不同的腹部和开放性血管手术（OR 0.75；95%CI 0.43-1.33， = 0.33）中，使用层流通风和常规通风的手术之间没有发现显著差异。手术室通风类型可能不会对手术部位感染产生影响，因为它不是降低手术部位感染发生率的工具。
基于这项荟萃分析，在层流或常规通风下进行手术可能与手术部位感染的风险没有独立关系。这种关系迫使我们不推荐使用层流通风，因为它的成本比常规通风高得多。
