Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
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Original Article

Volume 16, Number 7-8, August 2024, pages 345-354

Effect of Comorbidities on the Incidence of Surgical Site Infection in Patients Undergoing Emergency Surgery: A Systematic Review and Meta-Analysis

Figures

↓  Figure 1. Literature search flow chart.
Figure 1.
↓  Figure 2. Forest plot of meta-analysis on the effect of diabetes mellitus on SSI. CI: confidence interval; SSI: surgical site infection.
Figure 2.
↓  Figure 3. Forest plot of meta-analysis on the effect of hypertension on SSI. CI: confidence interval; SSI: surgical site infection.
Figure 3.
↓  Figure 4. Forest plot of meta-analysis on the effect of obesity on SSI. CI: confidence interval; SSI: surgical site infection.
Figure 4.
↓  Figure 5. Forest plot of meta-analysis on the effect of pulmonary disease on SSI. CI: confidence interval; SSI: surgical site infection.
Figure 5.
↓  Figure 6. Forest plot of meta-analysis on the effect of cardiac disease on SSI. CI: confidence interval; SSI: surgical site infection.
Figure 6.
↓  Figure 7. Forest plot of meta-analysis on the effect of liver disease on SSI. CI: confidence interval; SSI: surgical site infection.
Figure 7.
↓  Figure 8. Forest plot of meta-analysis on the effect of renal disease on SSI. SSI: surgical site infection.
Figure 8.

Tables

↓  Table 1. Characteristics of the Included Studies in the Meta-Analysis
 
First author, year Country Design Patients’ characteristics Sample size Mean age (years) Male, n (%) Incidence of SSI, n (%)
PC: prospective cohort; RC: retrospective cohort; SSI: surgical site infection; NR: not reported.
El-Kholy et al, 2018 [15] Egypt PC Patients underwent emergency general surgery 99 43 67 (68) 33 (6.7)
Fernandez-Moure et al, 2021 [16] USA RC Patients underwent emergency exploratory laparotomy 4,738 50 NR 632 (15.2)
Isbell et al, 2021 [17] USA RC Patients underwent emergency trauma laparotomy 1,322 33 1,032 (78) 88 (7)
Khan et al, 2022 [18] Bangladesh PC Patients underwent emergency abdominal surgery 112 37 85 (76) 17 (15.2)
Li et al, 2021 [19] China PC Patients underwent emergency abdominal surgery 953 49 534 (56) 71 (7.5)
Mathew et al, 2015 [20] India PC Patients underwent emergency general surgery 132 35 97 (73) 33 (25)
Narueponjirakul et al, 2021 [21] USA RC Patients underwent emergency colon surgery 236 67 101 (43) 61 (25.8)
Pandey et al, 2016 [22] India PC Patients underwent emergency general surgery 108 46 81 (75) 18 (16.7)
Papadopoulos et al, 2021 [23] Greece PC Patients underwent emergency general surgery 838 51 470 (56) 157 (18.7)
Watanabe et al, 2014 [24] Japan RC Patients underwent emergency colorectal surgery 78 61 45 (58) 25 (32.1)
Yang et al, 2015 [25] China RC Patients underwent emergency hernia surgery 121 68 100 (83) 9 (7.4)
Feng et al, 2022 [26] China RC Patients underwent emergency ileus surgery 125 62 67 (54) 37 (29.6)
Yadav et al, 2023 [27] Nepal PC Patients underwent emergency abdominal surgery 90 43 62 (69) 29 (32.2)

 

↓  Table 2. Quality Assessment of the Included Studies by Newcastle-Ottawa Scale
 
First author, year Selection Comparability Outcome Total score
El-Kholy et al, 2018 [15] 3 2 2 7
Fernandez-Moure et al, 2021 [16] 4 2 3 9
Isbell et al, 2021 [17] 4 2 3 9
Khan et al, 2022 [18] 4 2 3 9
Li et al, 2021 [19] 4 2 3 9
Mathew et al, 2015 [20] 4 2 2 8
Narueponjirakul et al, 2021 [21] 3 2 3 8
Pandey et al, 2016 [22] 3 2 2 7
Papadopoulos et al, 2021 [23] 4 2 3 9
Watanabe et al, 2014 [24] 4 2 3 9
Yang et al, 2015 [25] 3 2 3 8
Feng et al, 2022 [26] 4 2 3 9
Yadav et al, 2023 [27] 4 2 2 8

 

↓  Table 3. Meta-Analysis of the Effect of Comorbidities on SSI in Patients Undergoing Emergency Surgery
 
Risk factor Studies I2 (%) OR 95% CI P value
SSI: surgical site infection; OR: odds ratio; CI: confidence interval.
Diabetes mellitus 11 67 2.22 1.52 - 3.25 < 0.0001
Hypertension 4 62 0.95 0.62 - 1.47 0.82
Obesity 5 47 1.43 1.19 - 1.72 0.0001
Pulmonary disease 4 64 1.39 0.83 - 2.32 0.21
Cardiac disease 4 61 1.35 0.90 - 2.01 0.14
Liver disease 3 0 1.66 1.37 - 2.00 < 0.00001
Renal disease 4 0 1.04 0.85 - 1.28 0.67