Abstract：
BACKGROUND: Bundles have shown to improve patient outcomes in several settings. Surgical site infections (SSIs) following joint replacement surgery are associated with severe outcomes. We aimed to determine the effectiveness of non-pathogen specific bundled interventions in reducing SSIs after hip arthroplasty procedures.
METHODS: A systematic review and meta-analysis were conducted according to the PRISMA statement guidelines (PROSPERO registration number CRD42020203031). PubMed, Embase and Cochrane databases were searched for studies evaluating SSI prevention bundles in hip replacement surgery, excluding studies evaluating pathogen-specific bundles. Records were independently screened by two authors. The primary outcome was the SSI rate in intervention and control groups or before and after bundle implementation. Secondary outcomes of interest were bundle compliance and the number and type of bundle components. A meta-analysis was conducted using raw data, by calculating pooled relative risk (RR) SSI estimates to assess the impact of bundled interventions on SSI reduction.
RESULTS: Eleven studies were included in the qualitative review and four studies comprising over 20 000 patients were included in the quantitative synthesis. All included studies found bundles were associated with reduced SSI rates. The pooled RR estimated from the fixed-effects model was 0.76 (95% confidence interval 0.61-0.96, p 0.022) with 49.8% heterogeneity.
CONCLUSIONS: Results support the effectiveness of non-pathogen specific bundled interventions in preventing SSIs following hip arthroplasty. A \"core\" group of evidence-based elements for bundle development were identified.
METHODS: A systematic review and meta-analysis were conducted according to the PRISMA statement guidelines (PROSPERO registration number CRD42020203031). PubMed, Embase and Cochrane databases were searched for studies evaluating SSI prevention bundles in hip replacement surgery, excluding studies evaluating pathogen-specific bundles. Records were independently screened by two authors. The primary outcome was the SSI rate in intervention and control groups or before and after bundle implementation. Secondary outcomes of interest were bundle compliance and the number and type of bundle components. A meta-analysis was conducted using raw data, by calculating pooled relative risk (RR) SSI estimates to assess the impact of bundled interventions on SSI reduction.
RESULTS: Eleven studies were included in the qualitative review and four studies comprising over 20 000 patients were included in the quantitative synthesis. All included studies found bundles were associated with reduced SSI rates. The pooled RR estimated from the fixed-effects model was 0.76 (95% confidence interval 0.61-0.96, p 0.022) with 49.8% heterogeneity.
CONCLUSIONS: Results support the effectiveness of non-pathogen specific bundled interventions in preventing SSIs following hip arthroplasty. A \"core\" group of evidence-based elements for bundle development were identified.
摘要：
背景：在几种情况下，束能改善患者的预后。关节置换手术后的手术部位感染（SSIs）与严重的预后相关。我们旨在确定非病原体特异性捆绑干预措施在减少髋关节置换术后SSI的有效性。
方法：根据PRISMA声明指南（PROSPERO注册号CRD4202020203031）进行系统综述和荟萃分析。PubMed,搜索Embase和Cochrane数据库，用于评估髋关节置换手术中的SSI预防束的研究。不包括评估病原体特异性束的研究。记录由两位作者独立筛选。主要结果是干预组和对照组或捆绑实施前后的SSI率。感兴趣的次要结果是捆绑依从性和捆绑组件的数量和类型。使用原始数据进行荟萃分析，通过计算合并相对风险(RR)SSI估计值来评估捆绑干预措施对降低SSI的影响.
结果：11项研究纳入了定性综述，4项研究纳入了超过20.000名患者。所有纳入的研究都发现捆绑与降低的SSI率相关。固定效应模型估计的合并RR为0.76（95％置信区间0.61-0.96，p0.022），异质性为49.8％。
结论：结果支持非病原体特异性捆绑干预措施在预防髋关节置换术后SSIs的有效性。确定了用于捆绑开发的“核心”一组基于证据的元素。
方法：根据PRISMA声明指南（PROSPERO注册号CRD4202020203031）进行系统综述和荟萃分析。PubMed,搜索Embase和Cochrane数据库，用于评估髋关节置换手术中的SSI预防束的研究。不包括评估病原体特异性束的研究。记录由两位作者独立筛选。主要结果是干预组和对照组或捆绑实施前后的SSI率。感兴趣的次要结果是捆绑依从性和捆绑组件的数量和类型。使用原始数据进行荟萃分析，通过计算合并相对风险(RR)SSI估计值来评估捆绑干预措施对降低SSI的影响.
结果：11项研究纳入了定性综述，4项研究纳入了超过20.000名患者。所有纳入的研究都发现捆绑与降低的SSI率相关。固定效应模型估计的合并RR为0.76（95％置信区间0.61-0.96，p0.022），异质性为49.8％。
结论：结果支持非病原体特异性捆绑干预措施在预防髋关节置换术后SSIs的有效性。确定了用于捆绑开发的“核心”一组基于证据的元素。
