A commentary on “surgical site infection prevention through bundled interventions in hip replacement surgery: A systematic review” (Int J Surg 2021; 106149)
Bibliographic record
Abstract
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].
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".