Delayed primary skin closure reduce surgical site infection following surgery for gastrointestinal perforation: A systematic review and meta-analysis.

IF 2.1 3区 医学 Q2 SURGERY
Cangyuan Zhang, Jiajie Zhou, Longhe Sun, Daofu Zhang, Lei Xia, Shuai Zhao, Yayan Fu, Ruiqi Li
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引用次数: 0

Abstract

Background: Following surgery for Gastrointestinal (GI) perforation, there is an increased occurrence of Surgical Site Infections (SSI). The beneficial effect of employing delayed primary skin closure (DPC) on severely contaminated incisions subsequent to surgery for GI perforation remains unverified.

Objective: To systematically evaluate the advantages of the DPC management in surgery for GI perforation.

Methods: A literature search was performed using ClinicalTrials.gov, Pubmed, Embase, Cocharane, and Web of Science identified all eligible English-language studies related to surgery for GI perforation through October 2023. Randomized clinical trials (RCTs) comparing DPC with primary skin closure (PC) in surgery for GI perforation were included. Two investigators independently performed the inclusion work, and a third investigator was consulted for resolving conflicts. Data were extracted by multiple independent investigators and pooled in a random-effects model. The primary outcome was SSI, defined in accordance with the original studies. The secondary outcome was the length of stay (LOS).

Results: Final analysis included 12 RCTs which included a total of 903 patients were randomizing divided into either DPC or PC, including 289 patients with gastroduodenal perforation (32%), 144 patients with small intestine perforation (15.96%), 60 patients with colon perforation (6.64%), and 410 patients with appendix perforation (45.4%). The rates of SSI was significantly decreased after DPC management (OR:0.31, 95%CI:0.15-0.63, p < 0.01), no significant differences were observed between the DPC group and PC group in terms of LOS (MD: - 0.37, 95% CI: - 1.91-1.16, p = 0.63).

Conclusion: These results point to the efficacy of DPC management in reducing SSI in patients under surgery for GI perforation, and this strategy did not increase the LOS. This systematic review and meta-analysis may contribute to informed decision-making in the management of severely contaminated wounds associated with GI perforation.

延迟初级皮肤闭合可减少胃肠道穿孔手术后的手术部位感染:系统回顾和荟萃分析。
背景:胃肠道(GI)穿孔手术后,手术部位感染(SSI)的发生率增加。对消化道穿孔手术后严重污染的切口采用延迟原位皮肤闭合术(DPC)的有益效果仍未得到证实:目的:系统评估消化道穿孔手术中 DPC 管理的优势:方法:使用 ClinicalTrials.gov、Pubmed、Embase、Cocharane 和 Web of Science 进行文献检索,确定了截至 2023 年 10 月与消化道穿孔手术相关的所有符合条件的英文研究。研究纳入了在消化道穿孔手术中比较 DPC 与原发性皮肤闭合术 (PC) 的随机临床试验 (RCT)。两位研究者独立完成了纳入工作,并咨询了第三位研究者以解决冲突。数据由多名独立研究者提取,并通过随机效应模型进行汇总。主要结果是 SSI,其定义与原始研究一致。次要结果是住院时间(LOS):最终分析包括 12 项研究,共有 903 名患者被随机分为 DPC 或 PC,其中包括 289 名胃十二指肠穿孔患者(32%)、144 名小肠穿孔患者(15.96%)、60 名结肠穿孔患者(6.64%)和 410 名阑尾穿孔患者(45.4%)。经过 DPC 处理后,SSI 的发生率明显降低(OR:0.31,95%CI:0.15-0.63,p 结论:DPC 对肠穿孔患者的疗效显著:这些结果表明,DPC 处理能有效减少因消化道穿孔而接受手术的患者的 SSI,而且这种策略不会增加患者的住院时间。这项系统性回顾和荟萃分析可能有助于在处理与消化道穿孔相关的严重污染伤口时做出明智的决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.30
自引率
8.70%
发文量
342
审稿时长
4-8 weeks
期刊介绍: Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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