Meta-analysis of total versus partial graft excision: Which is the better choice to manage arteriovenous dialysis graft infection?

IF 1.5 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Annals of Saudi Medicine Pub Date : 2022-09-01 DOI:10.5144/0256-4947.2022.343

Thawatchai Tullavardhana, Anuwat Chartkitchareon

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引用次数: 3

Abstract

Background: Arteriovenous graft infection (AVGI) is a major cause of hemodialysis access failure. Delayed diagnosis and inappropriate treatment may lead to increased morbidity (3-35%) and mortality up to 12%.

Objectives: Compare the postoperative outcomes of total graft excision (TGE) and partial graft excision (PGE) in the treatment of AVGI.

Designs: Systematic review and meta-analysis METHODS: The dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for articles outlining the terms arteriovenous graft infection, infected dialysis graft, TGE and PGE published between 1995-2020. The data analysis evaluated the outcomes of TGE and PGE in the management of AVGI. The meta-analysis was performed using Review Manager Software version 5.4.1.

Main outcome measures: 30-day mortality, recurrent infection, and reoperation rate.

Sample size: Eight studies, including 555 AVGI, and 528 patients.

Results: PGE showed a significant increase in recurrent graft infection rate (OR=0.23,95% CI=0.13-0.41, P<.00001) and re-operation rate for control of infection (OR=0.14,95% CI=0.03-0.58, P<.007). However, the 30-day mortality rate did not differ significantly between the groups (OR=0.92,95% CI=0.39-2.17, P=.85).

Conclusions: TGE remains a safe and effective surgical method for the management of AVGI. PGE is associated with a higher risk of graft infection and need for re-operation. As a result, PGE should only be considered in carefully selected patients.

Limitation: Risk of bias due to the differences in patient characteristics.

Conflict of interest: None.

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全切除与部分切除的meta分析:哪个是治疗动静脉透析移植物感染的更好选择?

背景:动静脉移植物感染(AVGI)是导致血液透析通路失败的主要原因。延迟诊断和不适当治疗可能导致发病率增加(3-35%)，死亡率高达12%。目的:比较全移植物切除(TGE)与部分移植物切除(PGE)治疗AVGI的术后效果。方法:通过检索PubMed、EMBASE、Google Scholar和Cochrane数据库，检索1995-2020年间发表的关于动静脉移植物感染、感染透析移植物、TGE和PGE等术语的文章，定义数据集。数据分析评价TGE和PGE治疗AVGI的效果。meta分析使用Review Manager软件版本5.4.1进行。主要观察指标:30天死亡率、再感染率、再手术率。样本量:8项研究，包括555名AVGI患者和528名患者。结果:PGE明显增加了移植物复发感染率(OR=0.23,95% CI=0.13-0.41, PPP= 0.85)。结论:TGE是一种安全有效的治疗AVGI的手术方法。PGE与移植物感染的高风险和再次手术的需要相关。因此，PGE只应在精心挑选的患者中考虑。局限性:由于患者特征的差异，存在偏倚风险。利益冲突:无。

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来源期刊

Annals of Saudi Medicine 医学-医学：内科

CiteScore

2.80

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.