Fan Cheng-Wei, Chen Po-Huang, Jhou Hong-Jie, Cheng Yi-Chiao
Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Int J Colorectal Dis. 2023 Mar 18;38(1):73. doi: 10.1007/s00384-023-04353-5.
Recent evidence-based publications disclosed that negative pressure wound therapy (NPWT) may reduce the incidence rate of surgical site infection (SSI) and length of stay (LOS) compared with conventional drainage in patient status post abdominoperineal resection (APR) and extralevator abdominoperineal excision (ELAPE).
Data sources: Eligible randomized controlled trials and retrospective and prospective studies published before January 2023 were retrieved from databases (Cochrane Library, PubMed, and Embase).
(a) The study involved patients undergoing ELAPE or APR with postoperative NPWT; (b) the study compared NWPT with conventional drainage and reported at least one outcome of interest (i.e., SSI); and (c) the study provided adequate information to calculate the effect estimated for meta-analysis.
We calculated the odds ratio (ORs) and mean differences (MDs) with 95% confidence intervals (CIs).
The measure outcomes included surgical site infection(SSI) and length of stay (LOS).
Eight articles, involving 547 patients, met the selection criteria. Compared to conventional drainage, NPWT was associated with a significantly lower SSI rate (fixed effect, OR 0.29; 95% CI 0.18-0.45; I = 0%) in eight studies and 547 patients. Besides, NPWT was associated with a shorter LOS (fixed effect, MD - 2.00; CI - 2.60 to - 1.39; I = 0%) than conventional drainage in three studies and 305 patients. In a trial sequential analysis, the cumulative number of patients in the analyses of both outcomes exceeded the required information size and surpassed the significance boundary in favor of NPWT, suggesting conclusive results.
NPWT is superior to conventional drainage in both SSI rate and LOS, and the statistical power of SSI and LOS are confirmed by trial sequential analysis.
最近基于证据的出版物披露，与传统引流相比，负压伤口治疗（NPWT）可能会降低腹会阴联合切除术（APR）和肛提肌外腹会阴切除术（ELAPE）术后患者手术部位感染（SSI）的发生率和住院时间（LOS）。
数据来源：从数据库（考克兰图书馆、PubMed和Embase）中检索2023年1月之前发表的符合条件的随机对照试验以及回顾性和前瞻性研究。
（a）该研究涉及接受ELAPE或APR并术后采用NPWT的患者；（b）该研究将NPWT与传统引流进行比较，并报告了至少一项感兴趣的结果（即SSI）；（c）该研究提供了足够的信息来计算荟萃分析的效应估计值。
我们计算了比值比（OR）和平均差（MD）以及95%置信区间（CI）。
测量的结局包括手术部位感染（SSI）和住院时间（LOS）。
八项文章，涉及547名患者，符合选择标准。在八项研究的547名患者中，与传统引流相比，NPWT与显著更低的SSI率相关（固定效应，OR 0.29；95% CI 0.18 - 0.45；I = 0%）。此外，在三项研究的305名患者中，与传统引流相比，NPWT与更短的住院时间相关（固定效应，MD -2.00；CI -2.60至-1.39；I = 0%）。在一项试验序贯分析中，两项结局分析中的累积患者数量超过了所需信息规模并超过了支持NPWT的显著性边界，表明结果具有决定性。
NPWT在SSI率和住院时间方面均优于传统引流，并且试验序贯分析证实了SSI和住院时间的统计效力。
