腹部手术后使用伤口保护器减少手术部位感染的临床效果：荟萃分析。

The clinical effectiveness of wound edge protectors in reducing surgical site infection after abdominal surgery: meta-analysis.

机构信息

Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.

出版信息

BJS Open. 2022 May 2;6(3). doi: 10.1093/bjsopen/zrac065.

BACKGROUND

Surgical site infection (SSI) is a common complication after abdominal surgery. The effectiveness of wound edge protectors in reducing infection of the surgical sites is still unclear. The purpose of this study was to determine the clinical effectiveness of a wound edge protector (WEP) in reducing SSI rates after abdominal surgery.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched to obtain relevant articles published up to September 2021. Publications were retrieved if they contain primary data on the use of WEPs in reducing SSI compared with standard care in patients undergoing abdominal surgery. Subgroup analyses were performed for different WEP types, surgical sites, and levels of contamination. The outcome of interest was a clinically defined SSI. Qualitative variables were pooled using risk ratios (RRs).

RESULTS

Twenty-two eligible randomized clinical trials involving 4492 patients were included in this meta-analysis. WEP was associated with the reduced incidence of overall SSI (RR = 0.66; 95 per cent c.i. 0.53 to 0.83; P = 0.0003), and superficial SSI (RR = 0.59; 95 per cent c.i. 0.38 to 0.91; P = 0.02). In addition, WEP also successfully reduced the risk of SSI in clean-contaminated wounds (RR = 0.61; 95 per cent c.i. 0.40 to 0.93; P = 0.02) as well as in contaminated wounds (RR = 0.47; 95 per cent c.i. 0.33 to 0.67; P < 0.0001); however, WEP did not reduce SSI incidence in colorectal surgery (RR = 0.68; 95 per cent c.i. 0.46 to 1.01; P = 0.05).

CONCLUSION

This study suggests that WEP was efficient in reducing superficial SSI. Both double-ringed and single-ringed devices were efficient in reducing SSI. WEP was effective in reducing SSI incidence in clean-contaminated and contaminated surgery; however, its use does not reduce the SSI rate in colorectal surgery.

背景

手术部位感染（SSI）是腹部手术后常见的并发症。伤口保护器在降低手术部位感染方面的有效性尚不清楚。本研究旨在确定腹部手术后使用伤口保护器（WEP）降低 SSI 发生率的临床效果。

方法

系统检索 PubMed、Embase、Web of Science 和 Cochrane 图书馆，以获取截至 2021 年 9 月发表的与 WEPs 用于降低腹部手术患者 SSI 发生率与标准护理相比的相关文章。如果出版物包含 WEPs 用于降低不同手术部位和污染程度的 SSI 发生率的原始数据，则将其检索出来。进行了亚组分析，以确定不同 WEP 类型、手术部位和污染程度。关注的结果是临床定义的 SSI。使用风险比（RR）汇总定性变量。

结果

本荟萃分析纳入了 22 项符合条件的随机临床试验，涉及 4492 名患者。WEP 与总体 SSI 发生率降低相关（RR=0.66；95%可信区间 0.53 至 0.83；P=0.0003），与浅表 SSI 发生率降低相关（RR=0.59；95%可信区间 0.38 至 0.91；P=0.02）。此外，WEP 还成功降低了清洁污染伤口（RR=0.61；95%可信区间 0.40 至 0.93；P=0.02）和污染伤口（RR=0.47；95%可信区间 0.33 至 0.67；P<0.0001）的 SSI 风险；然而，WEP 并未降低结直肠手术中的 SSI 发生率（RR=0.68；95%可信区间 0.46 至 1.01；P=0.05）。