SSO and mesh prophylactic for Incisional Hernia

Background: The use of mesh is the standard for the prevention of incisional hernia (IH). However, the effect of surgical site occurrence (SSO) has never been compared. The aim of this meta-analysis was to evaluate the prevalence of SSO and measure its negative effect through the calculation of the number needed to treat for net effect (NNT net).
Methods: A meta-analysis was performed according to the PRISMA guidelines. The primary objective was to determine the prevalence of SSO and IH, and the secondary objective was to determine the NNT net as a metric to measure the combined benefits and harms. Only published clinical trials were included. The risk of bias was analyzed, and the random effects model was used to determine statistical significance.
Results: 15 studies comparing 2,344 patients were included. The incidence of IH was significantly lower in the mesh group than in the control group, with an OR of 0.29 (95% CI 0.16-0.49 p= 0.0001). The incidence of SSO was significantly high in the mesh group than in the control group, with an OR of 1.21 (95% CI 0.85-1.72 p=0.0001). So, the way to compare the benefits and risks of each of the studies was done with the calculation of the Number Needed to Treat for net effect NNTnet, which is the average number of patients who are needed to be treated to see the benefit exceeding the harm by one event, and the result was 5, which is the average number of patients who are needed to be treated to see the benefit exceeding the harm by one event.
Conclusion: The use of the mesh reduces the prevalence of IH and increases the prevalence of SSO, but NNT net determined that the use of mesh continues to be beneficial for the patient.

背景：网状结构的应用是预防切口疝（IH）的标准做法。然而，关于手术部位感染（SSO）的发生率，尚未有直接的比较研究。本项荟萃分析旨在评估SSO的发生率，并通过计算净效应所需治疗人数（NNT net）来衡量其负面影响。方法：本研究遵循PRISMA指南进行荟萃分析。主要目标为确定SSO和IH的发生率，次要目标为确定NNT net作为衡量综合效益与风险的指标。仅纳入已发表的随机临床试验。对偏倚风险进行分析，并采用随机效应模型以确定统计显著性。结果：纳入了15项研究，比较了2,344名患者。与对照组相比，网状结构组IH的发生率显著降低，OR值为0.29（95% CI 0.16-0.49，p=0.0001）。而网状结构组SSO的发生率则显著高于对照组，OR值为1.21（95% CI 0.85-1.72，p=0.0001）。因此，本研究通过计算净效应所需治疗人数NNT net来比较各研究的效益与风险，结果显示为5，即平均需要治疗5名患者以看到效益超过伤害的事件发生。结论：使用网状结构可降低IH的发生率并增加SSO的发生率，但NNT net分析表明，使用网状结构对患者仍具有持续的治疗益处。