Lancet Glob Health. 2024 Feb;12(2):e235-e242. doi: 10.1016/S2214-109X(23)00538-7.
Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI.
A decision-analytic model was built to estimate average costs and outcomes of changing gloves and instruments before abdominal wall closure compared with current practice. Clinical data were obtained from the ChEETAh trial, a multicentre, cluster-randomised trial in seven low-income and middle-income countries (LMICs), and costs were obtained from a study (KIWI) that assessed costs associated with SSIs in LMICs. Outcomes were measured as the percentage of surgeries resulting in SSIs. Costs were measured from a health-care provider perspective and were reported in 2021 US$. The economic analysis used a partially split single-country costing approach, with pooled outcomes data from all seven countries in the ChEETAh trial, and data for resource use and unit costs from India (KIWI); secondary analyses used resource use and costs from Mexico and Ghana (KIWI).
In the base case, the average cost of the intervention was $259∙92 compared with $261∙10 for current practice (cost difference -$1∙18, 95% CI -4∙08 to 1∙33). In the intervention group, an estimated 17∙6% of patients had an SSI compared with 19∙7% of patients in the current practice group (absolute risk reduction 2∙10%, 95% CI 2∙07-2∙84). At all cost-effectiveness thresholds assumed ($0 to $14 000), the intervention had a higher likelihood of being cost-effective compared with current practice, indicating that the intervention was cost-effective. Similar results were obtained when the analysis using data from India was repeated using resource use and unit cost data from Mexico and Ghana.
Routine sterile glove and instrument change before abdominal wall closure is effective and the costs are similar to those for current practice. Routine change of gloves and instruments before abdominal wall closure should be rolled out in LMICs.
National Institute for Health and Care Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, and Mölnlycke Healthcare.
手术部位感染（SSI）给患者和医疗系统带来了沉重负担。本研究评估了在关闭腹壁前常规更换无菌手套和器械以预防 SSI 的成本效益。
构建决策分析模型，以估计与当前实践相比，在关闭腹壁前更换手套和器械的平均成本和结果。临床数据来自 Cheetah 试验，这是一项在 7 个低收入和中等收入国家（LMIC）进行的多中心、集群随机试验，成本数据来自一项评估 LMIC 中 SSI 相关成本的研究（KIWI）。结果以导致 SSI 的手术百分比来衡量。成本从医疗保健提供者的角度进行衡量，并以 2021 年美元报告。经济分析采用部分拆分的单一国家成本核算方法，使用来自 Cheetah 试验的所有 7 个国家的汇总结果数据，以及来自印度（KIWI）的资源使用和单位成本数据；次要分析使用来自墨西哥和加纳（KIWI）的资源使用和成本数据。
在基础情况下，干预措施的平均成本为 259.92 美元，而当前实践的成本为 261.10 美元（成本差异-1.18 美元，95%CI-4.08 至 1.33）。在干预组中，估计有 17.6%的患者发生 SSI，而当前实践组中这一比例为 19.7%（绝对风险降低 2.10%，95%CI 2.07-2.84）。在所有假设的成本效益阈值（0 美元至 14000 美元）下，与当前实践相比，干预措施更有可能具有成本效益，这表明干预措施具有成本效益。当使用来自印度的数据进行分析时，使用来自墨西哥和加纳的资源使用和单位成本数据重复分析，得到了类似的结果。
在关闭腹壁前常规更换无菌手套和器械是有效的，且成本与当前实践相似。在 LMIC 中应推广在关闭腹壁前常规更换手套和器械。
英国国家卫生与保健优化研究所（NIHR）临床研究员奖、NIHR 全球健康研究单位资助以及莫灵克保健公司。
