■本研究旨在定量总结手术治疗胫骨骨折后与手术部位感染(SSI)相关的危险因素。
■我们搜索了Embase/Medline,科克伦图书馆,和Scopus数据库在2023年10月进行相关研究。我们纳入了原始研究,调查了手术治疗的创伤性胫骨骨折后SSI的危险因素,其中包括≥10名成年SSIs患者。当>5项研究调查相同的危险因素时,进行Meta分析。使用JoannaBriggs研究所队列研究的关键评估清单评估偏倚风险。
■这项研究包括42项研究,包括24,610例手术治疗的胫骨骨折患者和2,418例SSI病例。以下因素被确定为SSI的显著危险因素(p<0.05):骨筋膜室综合征(比值比[OR]=3.8,95%置信区间[CI]:2.4-6.0),输血(OR=3.8,95%CI:2.1-6.6),开放性骨折(OR=3.6,95%CI:2.5-5.1),Gustilo-Anderson分类>2(OR=3.1,95%CI:2.1-4.6),外固定架(OR=2.9,95%CI:2.3-3.8),美国麻醉医师协会分类>2(OR=2.5,95%CI:1.5-4.1),多发性创伤(OR=2.4,95%CI:1.5-4.0),双切口入路(OR=2.1,95%CI:1.5-3.0),吸烟(OR=1.8,95%CI:1.5-2.1),男性(OR=1.6,95%CI:1.3-1.8),高能创伤(OR=1.5,95%CI:1.1-2.1),手术时间延长(OR=0.62,0.43~0.82)。其他因素,包括糖尿病,高血压,和手术时间,未被确定为SSI的危险因素。然而,纳入的研究质量普遍较差,存在偏倚风险.
■该综述为术前评估患者发生SSI的风险提供了基础,可用于启动调整后的抗生素方案和更频繁的术后控制。此外,这表明未来研究在校正混杂因素时应包括的风险因素.
UNASSIGNED: This study aimed to quantitatively summarise risk factors associated with surgical site infection (SSI) following surgically managed tibial fractures.
UNASSIGNED: We searched the Embase/Medline, Cochrane Library, and Scopus databases for relevant studies in October 2023. We included original studies investigating risk factors for SSI following surgically managed traumatic tibial fractures that included ≥10 adult patients with SSIs. Meta-analysis was performed when >5 studies investigated the same risk factor. The risk of bias was assessed using the critical appraisal checklist from Joanna Briggs Institute for cohort studies.
UNASSIGNED: This study included 42 studies comprising 24,610 patients with surgically managed tibial fractures and 2,418 SSI cases. The following were identified as significant risk factors for SSI (p < 0.05): compartment syndrome (odds ratio [OR] = 3.8, 95% confidence interval [CI]: 2.4-6.0), blood transfusion (OR = 3.8, 95% CI: 2.1-6.6), open fracture (OR = 3.6, 95% CI: 2.5-5.1), Gustilo-Anderson classification >2 (OR = 3.1, 95% CI: 2.1-4.6), external fixation (OR = 2.9, 95% CI: 2.3-3.8), American Society of Anesthesiologists classification >2 (OR = 2.5, 95% CI: 1.5-4.1), polytrauma (OR = 2.4, 95% CI: 1.5-4.0), dual incision approach (OR = 2.1, 95% CI: 1.5-3.0), smoking (OR = 1.8, 95% CI: 1.5-2.1), male sex (OR = 1.6, 95% CI: 1.3-1.8), high energy trauma (OR = 1.5, 95% CI: 1.1-2.1), and prolonged surgery time (OR = 0.62, 0.43-0.82). Other factors, including diabetes, hypertension, and time to surgery, were not identified as risk factors for SSI. However, the included studies were generally of poor quality and at risk of bias.
UNASSIGNED: The
review provides a basis for preoperatively assessing a patient\'s risk of developing an SSI, which could be used to initiate adjusted antibiotic regimes and more frequent postoperative controls. Furthermore, it indicates the risk factors future research should include when adjusting for confounding factors.