口腔颌面部恶性肿瘤患者手术部位感染危险因素的meta分析

Meta analysis of risk factors for surgical site infection after oral and maxillofacial malignancies surgery

目的:系统评价口腔颌面部恶性肿瘤患者手术部位感染的危险因素。方法:检索CNKI、万方数据库、VIP、CBM,以及PubMed、EmBase、The Cochrane Library、Web of Science数据库,收集有关口腔颌面部恶性肿瘤患者发生手术部位感染的病例对照研究和队列研究,文献检索时间从建库至2023年1月,采用RevMan5.3软件进行meta分析。结果:共纳入13篇文献,包括4318例口腔颌面部恶性肿瘤患者。经meta分析,口腔颌面部恶性肿瘤发生手术部位感染的危险因素有糖尿病(OR=3.82,95%CI:2.21~6.62,P<0.0001)、ASA评分(OR=1.39,95%CI:1.22~1.59,P<0.0001)、BMI(<20 kg/m^(2))(OR=2.43,95%CI:1.85~3.18,P<0.0001)、手术方式(OR=4.39,95%CI:1.86~10.31,P=0.0007)、缺损修复方式(OR=5.29,95%CI:2.08~13.42,P=0.0005)、下颌骨切除术(OR=1.94,95%CI:1.04~3.61,P=0.04)、手术时长(OR=3.38,95%CI:1.22~9.38,P=0.02)、住院时间(≥18 d)(OR=26.33,95%CI:7.53~92.05,P<0.0001)、牙结石Ⅲ度(OR=7.29,95%CI:2.91~18.28,P<0.0001);保护因素有术前白蛋白>35 g/L(OR=0.11,95%CI:0.04~0.29,P<0.0001)。结论:口腔颌面部恶性肿瘤发生手术部位感染的危险强度由高到低为住院天数≥18 d、牙周结石Ⅲ度、缺损修复方式、手术方式、手术时长、糖尿病、BMI<20 kg/m^(2)、下颌骨切除术、高ASA评分;术前白蛋白值>35 g/L为保护因素。

PURPOSE:To systematically evaluate the risk factors of surgical site infection in patients with oral and maxillofacial malignant tumors.METHODS:Case control studies,cohort studies,on the incidence of surgical site infections in patients with oral and maxillofacial malignancies were searched and collected by searching the CNKI,Wanfang database,VIP,CBM,PubMed,EmBase,The Cochrane Library,and Web of Science databases.The search period was from the establishment to Jan,2023.RevMan5.3 were used for meta analysis.RESULTS:A total of 13 articles including 4318 patients with oral and maxillofacial malignant tumors were included.According to meta analysis,the risk factors for surgical site infection of oral and maxillofacial malignancies were diabetes(OR=3.82,95%CI:2.21-6.62,P<0.0001),ASA score(OR=1.39,95%CI:1.22-1.59,P<0.0001),BMI<20 kg/m^(2)(OR=2.43,95%CI:1.85-3.18,P<0.0001),surgical procedure(OR=4.39,95%CI:1.86-10.31,P=0.0007),defect repair method(OR=5.29,95%CI:2.08-13.42,P=0.0005),mandibulectomy(OR=1.94,95%CI:1.04-3.61,P=0.04),duration of surgery(OR=3.38,95%CI:1.22-9.38,P=0.02),length of hospital stay(≥18 days)(OR=26.33,95%CI:7.53~92.05,P<0.0001),preoperative periodontal calculus level 3(OR=7.29,95%CI:2.91-18.28,P<0.0001),and the protective factor was prealbumin>35 g/L(OR=0.11,95%CI:0.04-0.29,P<0.0001).CONCLUSIONS:The risk intensity of surgical site infection for malignant tumors in oral and maxillofacial region from high to low was:hospitalization days≥18,periodontal calculus level 3,defect repair method,surgical method,operation duration,diabetes mellitus,BMI<20 kg/m^(2),mandibular resection,high ASA score.Preoperative albumin>35 g/L was the protective factor.