A commentary on “surgical site infection prevention through bundled interventions in hip replacement surgery: A systematic review” (Int J Surg 2021; 106149)
Notice bibliographique
Résumé
Dear Editor, In the meta-analysis by Vicentini et al. [1] on effectiveness of non-pathogen-specific bundled interventions in reducing surgical site infection (SSI) after hip arthroplasty procedures recently published in the International Journal of Surgery(Int J Surg 2021; 106149), the authors concluded that the effectiveness of non-pathogen-specific bundled interventions in reducing SSI was 24%. However, there are some issues which need further consideration. First, the protocol (PROSPERO: CRD42020203031; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203031), the tool of risk of bias for non-randomized studies, should be Cochrane ROBINS-I. However, the tool used in this reported article is Newcastle-Ottawa Scale. ROBINS-I is the most widely used tool to assess the risk of bias of observational studies [2], while the Newcastle-Ottawa Scale should be used to evaluate quality of studies [3]. Although quality evaluation depends on assessing the risk of bias, these two tools are not the same because they consider different aspects of a study’s design, execution, validity, and precision. Second, the authors stated that this review focuses on patients receiving hip arthroplasty. However, patients coming from the study by Acklin et al. [4] received hemiarthroplasty, proximal femoral nail, and dynamic hip screw. The proportion of patients who received hip arthroplasty was only 36.4% in the control group and 35.9% in the intervention group. We tried to collect the data in the hip arthroplasty subgroup in this study but failed. Thus, only three studies provided sufficient raw data, and these studies should be the only studies to be included in the quantitative synthesis. On analysis of these studies, the pooled relative risk (RR) estimated from the fixed-effects model was 0.79 (95%CI: 0.63–1.00, P = 0.05) with heterogeneity I2 = 40% (Fig. 1). To assess the stability of this result, we changed the fixed-effects method to the random-effects method. The pooled RR was 0.59 (95%CI: 0.28–1.27, P = 0.18), with no significant statistical difference (Fig. 2). Thus, the authors should reconsider their conclusion made on the effectiveness of non-pathogen-specific bundled interventions.Fig. 1.: Meta-analysis of studies evaluating the impact of non-pathogen-specific bundled interventions on surgical site infections (SSIs) following hip arthroplasty. The outcome is risk ratio (RR) for SSI. Summary RR calculated with fixed-effects method under inverse variance method. The forest plot was from RevMan version 5.3.Fig. 2.: Meta-analysis of studies evaluating the impact of non-pathogen-specific bundled interventions on surgical site infections (SSIs) following hip arthroplasty. The outcome is risk ratio (RR) for SSI. Summary RR calculated with random-effects method under inverse variance method. The forest plot was from RevMan version 5.3.Actually, heterogeneity varied widely in the four quantitative studies [4–7]. As for follow-up, Vicentini et al. [7] reported it to be 8 years, while Acklin et al. [4] to be 10 months. The Bundle size ranged from 7 [7] to 22 [5] elements. Additionally, two studies [4,6] did not report the compliance rate which was reported to be 92.5% in the survey by Bullock et al. [5], and 77.3% by Vicentini et al. [7]. Therefore, we recommend not to pool the data to analyse, but instead just to give a detailed description. Even though there are some limitations in this systematic review, it still provides important messages in the field of hip arthroplasty. Provenance and peer review Commentary, internally reviewed. Please state any conflicts of interest The authors declare that they have no competing interests. Please state any sources of funding for your research No. Please state whether ethical approval was given, by whom and the relevant Judgement’s reference number Not applicable. The study was waived by the Ethics Committee of the Honghui Hospital, Xi’an Jiaotong University. Research registration Unique Identifying Number (UIN) No. Author contribution Conceived and designed the study: Bin-Fei Zhang; Wrote the manuscript: Bin-Fei Zhang. Guarantor Bin-Fei Zhang, e-mail: [email protected].
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,003 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».