School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
Ann Surg. 2023 Sep 1;278(3):e447-e456. doi: 10.1097/SLA.0000000000005867. Epub 2023 Mar 30.
The objective of this study is to evaluate the efficacy of strategies intended to prevent surgical site infection (SSI) after lower limb revascularization surgery.
SSIs are common, costly complications of lower limb revascularization surgery associated with significant morbidity and mortality.
We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 28, 2022). Two investigators independently screened abstracts and full-text articles, extracted data, and assessed the risk of bias. We included randomized controlled trials (RCTs) that evaluated strategies intended to prevent SSI after lower limb revascularization surgery for peripheral artery disease. We used random-effects models to pool data and GRADE to assess certainty.
Among 6258 identified citations, we included 26 RCTs (n=4752 patients) that evaluated 12 strategies to prevent SSI. Preincision antibiotics [risk ratio (RR)=0.25; 95% CI, 0.11-0.57; n=4 studies; I2 statistic=7.1%; high certainty] and incisional negative-pressure wound therapy (iNPWT) (RR=0.54; 95% CI, 0.38-0.78; n=5 studies; I2 statistic=7.2%; high certainty) reduced pooled risk of early (≤30 days) SSI. iNPWT also reduced the risk of longer-term (>30 days) SSI (pooled-RR=0.44; 95% CI, 0.26-0.73; n=2 studies; I2 =0%; low certainty). Strategies with uncertain effects on risk of SSI included preincision ultrasound vein mapping (RR=0.58; 95% CI, 0.33-1.01; n=1 study); transverse groin incisions (RR=0.33; 95% CI, 0.097-1.15; n=1 study), antibiotic-bonded prosthetic bypass grafts (RR=0.74; 95% CI, 0.44-1.25; n=1 study; n=257 patients), and postoperative oxygen administration (RR=0.66; 95% CI, 0.42-1.03; n=1 study) (low certainty for all).
Preincision antibiotics and iNPWT reduce the risk of early SSI after lower limb revascularization surgery. Confirmatory trials are required to determine whether other promising strategies also reduce SSI risk.
本研究旨在评估旨在预防下肢血运重建术后手术部位感染（SSI）的策略的疗效。
SSI 是下肢血运重建术后常见的、代价高昂的并发症，与显著的发病率和死亡率相关。
我们检索了 MEDLINE、EMBASE、CENTRAL 和循证医学评价（从建立到 2022 年 4 月 28 日）。两名调查员独立筛选摘要和全文文章，提取数据，并评估偏倚风险。我们纳入了评估旨在预防外周动脉疾病下肢血运重建术后 SSI 的策略的随机对照试验（RCT）。我们使用随机效应模型汇总数据，并使用 GRADE 评估确定性。
在 6258 条鉴定的引文，我们纳入了 26 项 RCT（n=4752 名患者），评估了 12 种预防 SSI 的策略。术前抗生素[风险比（RR）=0.25；95%CI，0.11-0.57；n=4 项研究；I2 统计量=7.1%；高确定性]和切口负压伤口治疗（iNPWT）[RR=0.54；95%CI，0.38-0.78；n=5 项研究；I2 统计量=7.2%；高确定性]降低了早期（≤30 天）SSI 的汇总风险。iNPWT 还降低了长期（>30 天）SSI 的风险（汇总 RR=0.44；95%CI，0.26-0.73；n=2 项研究；I2=0%；低确定性）。在 SSI 风险方面具有不确定效果的策略包括术前超声静脉成像（RR=0.58；95%CI，0.33-1.01；n=1 项研究）；横切口腹股沟切口（RR=0.33；95%CI，0.097-1.15；n=1 项研究），抗生素结合的人造旁路移植物（RR=0.74；95%CI，0.44-1.25；n=1 项研究；n=257 名患者）和术后吸氧治疗（RR=0.66；95%CI，0.42-1.03；n=1 项研究）（所有研究均为低确定性）。
术前抗生素和 iNPWT 降低了下肢血运重建术后早期 SSI 的风险。需要确证性试验来确定其他有前途的策略是否也能降低 SSI 风险。
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