Qi Zhou, Wenbo Meng, Yanhan Ren, Qinyuan Li, Marja A Boermeester, Peter Muli Nthumba, Jennifer Rickard, Bobo Zheng, Hui Liu, Qianling Shi, Siya Zhao, Zijun Wang, Xiao Liu, Zhengxiu Luo, Kehu Yang, Yaolong Chen, Robert G Sawyer
{"title":"术中生理盐水腹腔灌洗治疗腹腔感染的有效性:一项系统回顾和荟萃分析。","authors":"Qi Zhou, Wenbo Meng, Yanhan Ren, Qinyuan Li, Marja A Boermeester, Peter Muli Nthumba, Jennifer Rickard, Bobo Zheng, Hui Liu, Qianling Shi, Siya Zhao, Zijun Wang, Xiao Liu, Zhengxiu Luo, Kehu Yang, Yaolong Chen, Robert G Sawyer","doi":"10.1186/s13017-023-00496-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs.</p><p><strong>Methods: </strong>The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.</p><p><strong>Results: </strong>Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02-6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70-1.48]; I<sup>2</sup> = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18-2.86]; I<sup>2</sup> = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39-1.41]; I<sup>2</sup> = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74-3.93]; I<sup>2</sup> = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48-1.87]; I<sup>2</sup> = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45-2.09], I<sup>2</sup> = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16-6.98], I<sup>2</sup> = 0%) in patients with peritonitis when compared to non-IOPL.</p><p><strong>Conclusion: </strong>IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"24"},"PeriodicalIF":6.0000,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10061899/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis.\",\"authors\":\"Qi Zhou, Wenbo Meng, Yanhan Ren, Qinyuan Li, Marja A Boermeester, Peter Muli Nthumba, Jennifer Rickard, Bobo Zheng, Hui Liu, Qianling Shi, Siya Zhao, Zijun Wang, Xiao Liu, Zhengxiu Luo, Kehu Yang, Yaolong Chen, Robert G Sawyer\",\"doi\":\"10.1186/s13017-023-00496-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs.</p><p><strong>Methods: </strong>The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.</p><p><strong>Results: </strong>Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02-6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70-1.48]; I<sup>2</sup> = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18-2.86]; I<sup>2</sup> = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39-1.41]; I<sup>2</sup> = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74-3.93]; I<sup>2</sup> = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48-1.87]; I<sup>2</sup> = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45-2.09], I<sup>2</sup> = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16-6.98], I<sup>2</sup> = 0%) in patients with peritonitis when compared to non-IOPL.</p><p><strong>Conclusion: </strong>IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.</p>\",\"PeriodicalId\":48867,\"journal\":{\"name\":\"World Journal of Emergency Surgery\",\"volume\":\"18 1\",\"pages\":\"24\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2023-03-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10061899/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Emergency Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13017-023-00496-6\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Emergency Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13017-023-00496-6","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景:术中生理盐水腹腔灌洗(IOPL)已广泛应用于外科实践。然而，在腹腔内感染(IAIs)患者中，生理盐水IOPL的有效性仍然存在争议。本研究旨在系统回顾评价IOPL在IAIs患者中的有效性的随机对照试验(RCTs)。方法:检索PubMed、Embase、Web of Science、Cochrane library、中国知网(CNKI)、万方网(WanFang)、CBM等数据库，检索时间为建库至2022年12月31日。采用随机效应模型计算风险比(RR)、平均差和标准化平均差。建议评估、发展和评价分级(GRADE)用于评价证据的质量。结果:纳入10项随机对照试验，共1318名受试者，其中阑尾炎8项，腹膜炎2项。中等质量的证据显示，在生理盐水中使用IOPL与降低死亡风险无关(0% vs 1.1%;RR, 0.31 [95% CI, 0.02-6.39])，腹内脓肿(12.3% vs. 11.8%;Rr, 1.02 [95% ci, 0.70-1.48];I2 = 24%)，切口手术部位感染(3.3% vs. 3.8%;Rr, 0.72 [95% ci, 0.18-2.86];I2 = 50%)，术后并发症(11.0% vs. 13.2%;Rr, 0.74 [95% ci, 0.39-1.41];I2 = 64%)，再手术(2.9% vs. 1.7%;Rr,1.71 [95% ci, 0.74-3.93];I2 = 0%)和再入院率(5.2% vs. 6.6%;Rr, 0.95 [95% ci, 0.48-1.87];与非iopl患者相比，I2 = 7%)。低质量证据显示，使用IOPL和生理盐水与降低死亡风险无关(22.7% vs. 23.3%;RR, 0.97 [95% CI, 0.45-2.09]， I2 = 0%)和腹腔脓肿(5.1% vs. 5.0%;与非iopl患者相比，腹膜炎患者的RR为1.05 [95% CI, 0.16-6.98]， I2 = 0%)。结论:与非IOPL患者相比，使用生理盐水的IOPL与阑尾炎患者的死亡率、腹内脓肿、切口手术部位感染、术后并发症、再手术和再入院的风险没有显著降低。这些发现不支持在阑尾炎患者中常规使用生理盐水的IOPL。对于由其他类型腹部感染引起的IAI, IOPL的益处有待调查。
Effectiveness of intraoperative peritoneal lavage with saline in patient with intra-abdominal infections: a systematic review and meta-analysis.
Background: Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs.
Methods: The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.
Results: Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02-6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70-1.48]; I2 = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18-2.86]; I2 = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39-1.41]; I2 = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74-3.93]; I2 = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48-1.87]; I2 = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45-2.09], I2 = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16-6.98], I2 = 0%) in patients with peritonitis when compared to non-IOPL.
Conclusion: IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.
期刊介绍：
The World Journal of Emergency Surgery is an open access, peer-reviewed journal covering all facets of clinical and basic research in traumatic and non-traumatic emergency surgery and related fields. Topics include emergency surgery, acute care surgery, trauma surgery, intensive care, trauma management, and resuscitation, among others.
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