Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.
Department of Ear, Nose and Throat (Otolaryngology)-Head and Neck Surgery, University Hospital Augsburg, Augsburg, Germany; and.
Dermatol Surg. 2022 Oct 1;48(10):1046-1050. doi: 10.1097/DSS.0000000000003546. Epub 2022 Jul 15.
Identifying risk factors is essential for preventing surgical site infections (SSIs) in dermatologic surgery.
To analyze whether specific procedure-related factors are associated with SSI.
This systematic review of the literature included MEDLINE, EMBASE, CENTRAL, and trial registers. The Newcastle-Ottawa Scale was used for risk bias assessment. If suitable, the authors calculated risk factors and performed meta-analysis using random effects models. Otherwise, data were summarized narratively.
Fifteen observational studies assessing 25,928 surgical procedures were included. Seven showed good, 2 fair, and 6 poor study quality. Local flaps (risk ratio [RR] 3.26, 95% confidence intervall [CI] 1.92-5.53) and skin grafting (RR 2.95, 95% CI 1.37-6.34) were associated with higher SSI rates. Simple wound closure had a significantly lower infection risk (RR 0.34, 95% CI 0.25-0.46). Second intention healing showed no association with SSI (RR 1.82, 95% CI 0.40-8.35). Delayed wound closure may not affect the SSI rate. The risk for infection may increase with the degree of preoperative contamination. There is limited evidence whether excisions >20 mm or surgical drains are linked to SSI.
Local flaps, skin grafting, and severely contaminated surgical sites have a higher risk for SSI. Second intention healing and probably delayed wound closure are not associated with postoperative wound infection.
识别风险因素对于预防皮肤科手术部位感染（SSI）至关重要。
分析特定与手术相关的因素是否与 SSI 相关。
本系统文献回顾包括 MEDLINE、EMBASE、CENTRAL 和试验登记处。使用纽卡斯尔-渥太华量表进行风险偏倚评估。如果合适，作者使用随机效应模型计算风险因素并进行荟萃分析。否则，数据将以叙述性方式总结。
纳入了 15 项评估 25928 例手术的观察性研究。其中 7 项研究质量较好，2 项研究质量中等，6 项研究质量较差。局部皮瓣（风险比 [RR] 3.26，95%置信区间 [CI] 1.92-5.53）和植皮（RR 2.95，95% CI 1.37-6.34）与更高的 SSI 发生率相关。单纯伤口闭合的感染风险显著降低（RR 0.34，95% CI 0.25-0.46）。二期愈合与 SSI 无关联（RR 1.82，95% CI 0.40-8.35）。延迟伤口闭合可能不会影响 SSI 发生率。感染风险可能会随着术前污染程度的增加而增加。关于切除面积>20mm 或手术引流管是否与 SSI 相关的证据有限。
局部皮瓣、植皮和严重污染的手术部位发生 SSI 的风险较高。二期愈合和可能的延迟伤口闭合与术后伤口感染无关。
