JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
Syst Rev. 2024 Sep 28;13(1):246. doi: 10.1186/s13643-024-02634-w.
Fibrin sealants are increasingly used in head and neck surgery to aid hemostasis, but individual studies lack conclusive evidence. This systematic review investigates their effectiveness compared to placebo or usual care in head and neck surgery.
Studies comparing fibrin sealant to placebo or usual care in patients 18 years or older who have undergone soft tissue surgery of the head and neck with drain placement were included. Primary outcomes include wound complications and time to surgical drain removal postoperatively. Secondary outcomes include length of hospital stay, drain volume output, surgical management of hematoma, blood transfusion rates, and adverse reactions. Electronic databases were searched on October 2023 for randomized controlled and quasi-experimental studies. Studies underwent independent screening, review, and appraisal by two reviewers using JBI appraisal tools. Certainty was assessed with GRADE, and meta-analysis was conducted using JBI SUMARI, presenting effect sizes as relative risk ratios or mean differences with 95% confidence intervals.
Fourteen studies were included examining 904 patients. The fibrin sealant group exhibited reduced postoperative wound complications (hematoma, seroma, wound dehiscence, wound infection) (RR = 0.64, 95% CI = 0.45-0.92), shorter drain removal times (MD = - 0.49 days, 95% CI = - 0.68 to - 0.29), decreased drain output (MD = - 16.52 mL, 95% CI = - 18.56 to - 14.52), and shorter hospital stay (MD = - 0.84 days, 95% CI = - 1.11 to - 0.57) compared to controls. There was no statistically significant difference on the rate of intervention for postoperative hematoma and the rate of adverse reactions.
Evidence demonstrates with low certainty that fibrin sealant use is associated with a modest reduction in the rate of wound complications, drain duration, and length of stay, and a small reduction in drain volume output. Methodological weaknesses and clinical heterogeneity limit these findings. Further research should focus on enhancing methodological quality and exploring the cost-effectiveness of fibrin sealant use in surgery.
CRD42023412820.
Nil.
纤维蛋白胶在头颈部外科中越来越多地被用于辅助止血，但个别研究缺乏确凿的证据。本系统评价调查了它们在头颈部外科中与安慰剂或常规护理相比的有效性。
纳入了比较纤维蛋白胶与安慰剂或常规护理在 18 岁及以上接受头颈部软组织手术并放置引流管的患者的研究。主要结局包括伤口并发症和术后引流管移除时间。次要结局包括住院时间、引流管体积输出、血肿的手术处理、输血率和不良反应。2023 年 10 月，对电子数据库进行了检索，以获取随机对照和准实验研究。研究由两名评审员使用 JBI 评估工具进行独立筛选、审查和评估。使用 GRADE 评估确定性，并使用 JBI SUMARI 进行荟萃分析，以相对风险比或平均值差异（95%置信区间）呈现效应大小。
纳入了 14 项研究，共 904 名患者。纤维蛋白胶组术后伤口并发症（血肿、血清肿、伤口裂开、伤口感染）减少（RR=0.64，95%CI=0.45-0.92），引流管移除时间缩短（MD=-0.49 天，95%CI=-0.68 至-0.29），引流管输出量减少（MD=-16.52 毫升，95%CI=-18.56 至-14.52），住院时间缩短（MD=-0.84 天，95%CI=-1.11 至-0.57）与对照组相比。在术后血肿的干预率和不良反应率方面，无统计学意义的差异。
低确定性证据表明，纤维蛋白胶的使用与伤口并发症、引流管持续时间和住院时间的发生率略有降低以及引流管体积输出量略有减少有关。方法学上的弱点和临床异质性限制了这些发现。进一步的研究应侧重于提高方法学质量，并探索纤维蛋白胶在手术中的成本效益。
CRD42023412820。
无。
