目的:本荟萃分析旨在探讨预防性负压伤口治疗(NPWT)对骨科手术后深部手术部位感染(SSIs)发生的影响。
方法:在Medline进行了系统搜索,Embase,科克伦图书馆,和WebofScience数据库提供截至2024年5月20日接受骨科手术的患者的NPWT相关文章。使用Stata15.0,使用随机效应模型或固定效应模型计算组合赔率比(OR),取决于异质性值。
结果:在总共440种出版物中,选择以NPWT为实验组,以常规敷料为对照组的研究,分析其对SSIs的影响.最终,32项研究符合纳入标准。其中包括12项随机对照试验和20项队列研究,涉及7454名患者,其中3533人接受了NPWT,3921人接受了常规敷料治疗。荟萃分析的结果表明,NPWT组在骨科手术中深SSIs的发生率低于对照组[OR0.64,95%CI(0.52,0.80),P=0.0001]。亚组分析显示创伤手术有显著差异[OR0.65,95%CI(0.50,0.83),P=0.001],而关节手术[OR0.65,95%CI(0.38,1.12),P=0.122]和脊柱手术[OR0.61,95%CI(0.27,1.35),P=0.221]没有显示显著差异。此外,当根据异质性单独检查时,创伤手术表现出显著差异[OR0.50,95%CI(0.31,0.80),P=0.004]。
结论:我们的研究结果表明,与使用常规敷料相比,预防性使用NPWT可降低骨科创伤手术后深SSIs的发生率。我们推测,在骨创伤并发症高危患者中预防性应用NPWT可能会改善临床预后并增强患者预后。
OBJECTIVE: This meta-analysis aimed to explore the impact of prophylactic negative pressure wound therapy (NPWT) on the occurrence of deep surgical site infections (SSIs) following orthopedic surgery.
METHODS: A systematic search was conducted across Medline, Embase, Cochrane Library, and Web of Science databases for articles concerning NPWT in patients who underwent orthopedic surgery up to May 20, 2024. Using Stata 15.0, the combined odds ratios (ORs) were calculated with either a random-effects model or a fixed-effects model, depending on the heterogeneity values.
RESULTS: From a total of 440 publications, studies that utilized NPWT as the experimental group and conventional dressings as the control group were selected to analyze their impact on SSIs. Ultimately, 32 studies met the inclusion criteria. These included 12 randomized controlled trials and 20 cohort studies, involving 7454 patients, with 3533 of whom received NPWT and 3921 of whom were treated with conventional dressings. The results of the meta-analysis demonstrated that the NPWT group had a lower incidence of deep SSIs in orthopedic surgeries than did the control group [OR 0.64, 95% CI (0.52, 0.80), P = 0.0001]. Subgroup analysis indicated a notable difference for trauma surgeries [OR 0.65, 95% CI (0.50, 0.83), P = 0.001], whereas joint surgeries [OR 0.65, 95% CI (0.38, 1.12), P = 0.122] and spine surgeries [OR 0.61, 95% CI (0.27, 1.35), P = 0.221] did not show significant differences. Additionally, when examined separately according to heterogeneity, trauma surgeries exhibited a significant difference [OR 0.50, 95% CI (0.31, 0.80), P = 0.004].
CONCLUSIONS: The results of our study indicate that the prophylactic use of NPWT reduces the incidence of deep SSIs following orthopedic trauma surgery when compared to the use of conventional dressings. We postulate that the prophylactic application of NPWT in patients at high risk of developing complications from bone trauma may result in improved clinical outcomes and an enhanced patient prognosis.