■关于在原发性闭合性切口伤口(iNPWT)上预防性使用负压伤口治疗以预防手术部位感染(SSI)的证据令人困惑和模棱两可。当前国际准则和已发布的荟萃分析中的建议不一致,损害了日常实践中的实施。最近,多项新的随机对照试验(RCT)已经发表.我们旨在提供所有荟萃分析及其特征的概述;进行新的和最新的系统审查,荟萃分析和建议评估分级,开发和评估(GRADE)评估;并通过试验序贯分析(TSA)探索新RCT的附加价值。
■PubMed,从数据库开始到2022年10月24日搜索Embase和CochraneCENTRAL数据库。我们确定了现有的荟萃分析,涵盖了所有外科专业和随机对照试验,研究了iNPWT与标准敷料在所有类型手术中对SSI发生率的影响。伤口裂开,再操作,血清肿,血肿,死亡率,再入院率,皮肤起泡,皮肤坏死,疼痛,以及干预措施的不利影响。我们使用Mantel-Haenszel随机效应模型计算了相对风险(RR)和相应的95%置信区间(CI)。我们用比较调整的漏斗图评估了出版偏倚。TSA用于评估随机误差的风险。使用Cochrane偏差风险2(RoB2)工具和等级方法评估证据的确定性。这项研究在PROSPERO注册,CRD42022312995。
■我们确定了八个以前发表的调查iNPWT的一般meta分析,并将其结果与当前meta分析进行了比较。对于最新的系统审查,有13,744例患者的57例RCTs纳入了SSI的定量分析,与标准敷料相比,iNPWT的RR为0.67(95%CI:0.59-0.76,I2=21%)。证据的确定性很高。与以前的荟萃分析相比,RR稳定下来,置信区间缩小。在TSA中,累积Z曲线越过试验序贯监测边界以获得益处,从荟萃分析中确认汇总效应估计的稳健性。
■在此最新的荟萃分析中,等级评估显示高确定性证据表明iNPWT可有效降低SSI,不确定性比以前的荟萃分析要小。TSA指出,进一步的试验不太可能改变结果SSI的效果估计;因此,如果将来要对iNPWT进行研究,至关重要的是要考虑这些发现将有助于现有的有力证据。
■荷兰质量基金医疗专家协会。
UNASSIGNED: The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA).
UNASSIGNED: PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995.
UNASSIGNED: We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis.
UNASSIGNED: In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence.
UNASSIGNED: Dutch Association for Quality Funds Medical Specialists.