School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Eur J Vasc Endovasc Surg. 2024 Mar;67(3):455-467. doi: 10.1016/j.ejvs.2023.10.038. Epub 2023 Nov 2.
To systematically review and meta-analyse adjusted risk factors for surgical site infection (SSI) after lower limb revascularisation surgery.
MEDLINE, Embase, Evidence Based Medicine Reviews, and the Cochrane Central Register of Controlled Trials (inception to 28 April 2022).
Systematic review and meta-analysis conducted according to PRISMA guidelines. After protocol registration, databases were searched. Studies reporting adjusted risk factors for SSI in adults who underwent lower limb revascularisation surgery for peripheral artery disease were included. Adjusted odds ratios (ORs) were pooled using random effects models. GRADE was used to assess certainty.
Among 6 377 citations identified, 50 studies (n = 271 125 patients) were included. The cumulative incidence of SSI was 12 (95% confidence interval [CI] 10 - 13) per 100 patients. Studies reported 139 potential SSI risk factors adjusted for a median of 12 (range 1 - 69) potential confounding factors. Risk factors that increased the pooled adjusted odds of SSI included: female sex (pooled OR 1.41, 95% CI 1.20 - 1.64; high certainty); dependent functional status (pooled OR 1.18, 95% CI 1.03 - 1.35; low certainty); being overweight (pooled OR 1.82, 95% CI 1.29 - 2.56; moderate certainty), obese (pooled OR 2.20, 95% CI 1.44 - 3.36; high certainty), or morbidly obese (pooled OR 1.65, 95% CI 1.08 - 2.52; moderate certainty); chronic obstructive pulmonary disease (pooled OR 1.42, 95% CI 1.17 - 1.71; high certainty); chronic limb threatening ischaemia (pooled OR 1.67, 95% CI 1.22 - 2.29; moderate certainty); chronic kidney disease (pooled OR 2.13, 95% CI 1.18 - 3.83; moderate certainty); intra-operative (pooled OR 1.23, 95% CI 1.02 - 1.49), peri-operative (pooled OR 1.92, 95% CI 1.27 - 2.90), or post-operative (pooled OR 2.21, 95% CI 1.44 - 3.39) blood transfusion (moderate certainty for all); urgent or emergency surgery (pooled OR 2.12, 95% CI 1.22 - 3.70; moderate certainty); vein bypass and or patch instead of endarterectomy alone (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty); an operation lasting ≥ 3 hours (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty) or ≥ 5 hours (pooled OR 1.60, 95% CI 1.18 - 2.17; moderate certainty); and early or unplanned re-operation (pooled OR 4.50, 95% CI 2.18 - 9.32; low certainty).
This systematic review identified evidence informed SSI risk factors following lower limb revascularisation surgery. These may be used to develop improved SSI risk prediction tools and to identify patients who may benefit from evidence informed SSI prevention strategies.
系统回顾和荟萃分析下肢血运重建术后手术部位感染（SSI）的调整风险因素。
MEDLINE、Embase、循证医学评价数据库和 Cochrane 对照试验中心注册库（自成立至 2022 年 4 月 28 日）。
根据 PRISMA 指南进行系统回顾和荟萃分析。在方案注册后，检索数据库。纳入报告了外周动脉疾病患者下肢血运重建术后 SSI 调整风险因素的成人研究。使用随机效应模型汇总调整后的优势比（OR）。使用 GRADE 评估确定性。
在 6377 条引文中共确定了 50 项研究（n=271125 例患者）。SSI 的累积发生率为 12（95%置信区间 [CI]10-13）/100 例患者。研究报告了 139 个潜在的 SSI 风险因素，调整了中位数为 12（范围 1-69）个潜在混杂因素。增加 SSI 调整后比值比的风险因素包括：女性（汇总 OR 1.41，95%CI1.20-1.64；高确定性）；依赖功能状态（汇总 OR 1.18，95%CI1.03-1.35；低确定性）；超重（汇总 OR 1.82，95%CI1.29-2.56；中等确定性），肥胖（汇总 OR 2.20，95%CI1.44-3.36；高确定性）或病态肥胖（汇总 OR 1.65，95%CI1.08-2.52；中等确定性）；慢性阻塞性肺疾病（汇总 OR 1.42，95%CI1.17-1.71；高确定性）；慢性肢体威胁性缺血（汇总 OR 1.67，95%CI1.22-2.29；中等确定性）；慢性肾脏病（汇总 OR 2.13，95%CI1.18-3.83；中等确定性）；术中（汇总 OR 1.23，95%CI1.02-1.49）、围术期（汇总 OR 1.92，95%CI1.27-2.90）或术后（汇总 OR 2.21，95%CI1.44-3.39）输血（所有均为中等确定性）；紧急或急诊手术（汇总 OR 2.12，95%CI1.22-3.70；中等确定性）；静脉旁路和/或补片而非单纯内膜切除术（汇总 OR 1.86，95%CI1.33-2.59；中等确定性）；手术时间≥3 小时（汇总 OR 1.86，95%CI1.33-2.59；中等确定性）或≥5 小时（汇总 OR 1.60，95%CI1.18-2.17；中等确定性）；以及早期或计划外再次手术（汇总 OR 4.50，95%CI2.18-9.32；低确定性）。
本系统回顾确定了下肢血运重建术后 SSI 的证据支持风险因素。这些因素可用于开发改进的 SSI 风险预测工具，并确定可能受益于循证 SSI 预防策略的患者。
