Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis
BackgroundSurgical site infections (SSIs) are common, costly, and associated with increased morbidity and potential mortality after lower limb revascularization surgery (ie, arterial bypass, endarterectomy, and patch angioplasty). Identifying evidence-informed risk factors fo...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2021-09-01
|
| Series: | JMIR Research Protocols |
| Online Access: | https://www.researchprotocols.org/2021/9/e28759 |
| _version_ | 1827859058537791488 |
|---|---|
| author | Derek J Roberts Sudhir K Nagpal Henry T Stelfox Tim Brandys Vicente Corrales-Medina Luc Dubois Daniel I McIsaac |
| author_facet | Derek J Roberts Sudhir K Nagpal Henry T Stelfox Tim Brandys Vicente Corrales-Medina Luc Dubois Daniel I McIsaac |
| author_sort | Derek J Roberts |
| collection | DOAJ |
| description |
BackgroundSurgical site infections (SSIs) are common, costly, and associated with increased morbidity and potential mortality after lower limb revascularization surgery (ie, arterial bypass, endarterectomy, and patch angioplasty). Identifying evidence-informed risk factors for SSI in patients undergoing these surgeries is therefore important.
ObjectiveThe aim of this study is to conduct a systematic review and meta-analysis of prognostic studies to identify, synthesize, and determine the certainty in the cumulative evidence associated with reported risk factors for early and delayed SSI after lower limb revascularization surgery in adults with peripheral artery disease.
MethodsWe will search MEDLINE, Embase, the seven databases in Evidence-Based Medicine Reviews, review articles identified during the search, and included article bibliographies. We will include studies of adults (aged ≥18 years) with peripheral artery disease that report odds ratios, risk ratios, or hazard ratios adjusted for the presence of other risk factors or confounding variables and relating the potential risk factor of interest to the development of SSI after lower limb revascularization surgery. We will exclude studies that did not adjust for confounding, exclusively examined certain high-risk patient cohorts, or included >20% of patients who underwent surgery for indications other than peripheral artery disease. The primary outcomes will be early (in-hospital or ≤30 days) SSI and Szilagyi grade I (cellulitis involving the wound), grade II (infection involving subcutaneous tissue), and grade III (infection involving the vascular graft) SSI. Two investigators will independently extract data and evaluate the study risk of bias using the Quality in Prognosis Studies tool. Adjusted risk factor estimates with similar definitions will be pooled using DerSimonian and Laird random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. Finally, we will use the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to determine certainty in the estimates of association between reported risk factors and the development of SSI.
ResultsThe protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews). We will execute the peer-reviewed search strategy on June 30, 2021, and then complete the review of titles and abstracts and full-text articles by July 30, 2021, and September 15, 2021, respectively. We will complete the full-text study data extraction and risk of bias assessment by November 15, 2021. We anticipate that we will be able to submit the manuscript for peer review by January 30, 2022.
ConclusionsThis study will identify, synthesize, and determine the certainty in the cumulative evidence associated with risk factors for early and delayed SSI after lower limb revascularization surgery in patients with peripheral artery disease. The results will be used to inform practice, clinical practice statements and guidelines, and subsequent research.
Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42021242557; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242557
International Registered Report Identifier (IRRID)PRR1-10.2196/28759 |
| first_indexed | 2024-03-12T13:02:58Z |
| format | Article |
| id | doaj.art-df971537945748eab5c160c642c3b958 |
| institution | Directory Open Access Journal |
| issn | 1929-0748 |
| language | English |
| last_indexed | 2024-03-12T13:02:58Z |
| publishDate | 2021-09-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Research Protocols |
| spelling | doaj.art-df971537945748eab5c160c642c3b9582023-08-28T19:04:49ZengJMIR PublicationsJMIR Research Protocols1929-07482021-09-01109e2875910.2196/28759Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysisDerek J Robertshttps://orcid.org/0000-0001-6111-6291Sudhir K Nagpalhttps://orcid.org/0000-0002-4584-8975Henry T Stelfoxhttps://orcid.org/0000-0003-1231-1490Tim Brandyshttps://orcid.org/0000-0002-4569-7636Vicente Corrales-Medinahttps://orcid.org/0000-0002-9691-491XLuc Duboishttps://orcid.org/0000-0002-8828-6896Daniel I McIsaachttps://orcid.org/0000-0002-8543-1859 BackgroundSurgical site infections (SSIs) are common, costly, and associated with increased morbidity and potential mortality after lower limb revascularization surgery (ie, arterial bypass, endarterectomy, and patch angioplasty). Identifying evidence-informed risk factors for SSI in patients undergoing these surgeries is therefore important. ObjectiveThe aim of this study is to conduct a systematic review and meta-analysis of prognostic studies to identify, synthesize, and determine the certainty in the cumulative evidence associated with reported risk factors for early and delayed SSI after lower limb revascularization surgery in adults with peripheral artery disease. MethodsWe will search MEDLINE, Embase, the seven databases in Evidence-Based Medicine Reviews, review articles identified during the search, and included article bibliographies. We will include studies of adults (aged ≥18 years) with peripheral artery disease that report odds ratios, risk ratios, or hazard ratios adjusted for the presence of other risk factors or confounding variables and relating the potential risk factor of interest to the development of SSI after lower limb revascularization surgery. We will exclude studies that did not adjust for confounding, exclusively examined certain high-risk patient cohorts, or included >20% of patients who underwent surgery for indications other than peripheral artery disease. The primary outcomes will be early (in-hospital or ≤30 days) SSI and Szilagyi grade I (cellulitis involving the wound), grade II (infection involving subcutaneous tissue), and grade III (infection involving the vascular graft) SSI. Two investigators will independently extract data and evaluate the study risk of bias using the Quality in Prognosis Studies tool. Adjusted risk factor estimates with similar definitions will be pooled using DerSimonian and Laird random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. Finally, we will use the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to determine certainty in the estimates of association between reported risk factors and the development of SSI. ResultsThe protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews). We will execute the peer-reviewed search strategy on June 30, 2021, and then complete the review of titles and abstracts and full-text articles by July 30, 2021, and September 15, 2021, respectively. We will complete the full-text study data extraction and risk of bias assessment by November 15, 2021. We anticipate that we will be able to submit the manuscript for peer review by January 30, 2022. ConclusionsThis study will identify, synthesize, and determine the certainty in the cumulative evidence associated with risk factors for early and delayed SSI after lower limb revascularization surgery in patients with peripheral artery disease. The results will be used to inform practice, clinical practice statements and guidelines, and subsequent research. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42021242557; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242557 International Registered Report Identifier (IRRID)PRR1-10.2196/28759https://www.researchprotocols.org/2021/9/e28759 |
| spellingShingle | Derek J Roberts Sudhir K Nagpal Henry T Stelfox Tim Brandys Vicente Corrales-Medina Luc Dubois Daniel I McIsaac Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis JMIR Research Protocols |
| title | Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis |
| title_full | Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis |
| title_fullStr | Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis |
| title_full_unstemmed | Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis |
| title_short | Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis |
| title_sort | risk factors for surgical site infection after lower limb revascularization surgery in adults with peripheral artery disease protocol for a systematic review and meta analysis |
| url | https://www.researchprotocols.org/2021/9/e28759 |
| work_keys_str_mv | AT derekjroberts riskfactorsforsurgicalsiteinfectionafterlowerlimbrevascularizationsurgeryinadultswithperipheralarterydiseaseprotocolforasystematicreviewandmetaanalysis AT sudhirknagpal riskfactorsforsurgicalsiteinfectionafterlowerlimbrevascularizationsurgeryinadultswithperipheralarterydiseaseprotocolforasystematicreviewandmetaanalysis AT henrytstelfox riskfactorsforsurgicalsiteinfectionafterlowerlimbrevascularizationsurgeryinadultswithperipheralarterydiseaseprotocolforasystematicreviewandmetaanalysis AT timbrandys riskfactorsforsurgicalsiteinfectionafterlowerlimbrevascularizationsurgeryinadultswithperipheralarterydiseaseprotocolforasystematicreviewandmetaanalysis AT vicentecorralesmedina riskfactorsforsurgicalsiteinfectionafterlowerlimbrevascularizationsurgeryinadultswithperipheralarterydiseaseprotocolforasystematicreviewandmetaanalysis AT lucdubois riskfactorsforsurgicalsiteinfectionafterlowerlimbrevascularizationsurgeryinadultswithperipheralarterydiseaseprotocolforasystematicreviewandmetaanalysis AT danielimcisaac riskfactorsforsurgicalsiteinfectionafterlowerlimbrevascularizationsurgeryinadultswithperipheralarterydiseaseprotocolforasystematicreviewandmetaanalysis |