Effects of operating room nursing intervention on wound infection in patients undergoing ovarian cysts surgery: A meta-analysis

The flow chart of literature screening is shown in Figure  1 . A total of 541 documents were retrieved at the beginning of the study, 213 duplicates were removed manually and by software, 295 documents that were inconsistent with the study were removed by reading the titles and abstracts of the documents according to the screening criteria, and the remaining 33 documents were read in their entirety, and finally 15 RCTs were included, with a total of 1187 patients, 7 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 including 599 and 588 patients in the operating room nursing and routine nursing groups, respectively. The basic characteristics of the included literature are shown in Table  1 . The risk assessment of the literature is shown in Figure  2 . Flow chart of study selection process. Characteristics of the included studies. Note : NR means not report. The risk of bias graph of the included studies. Fifteen RCTs reported wound infections. There were 599 cases in the operating room nursing group, of which 7 had infections, and 588 cases in the routine nursing group, of which 32 had infections. No significant heterogeneity was found ( I 2  = 0%, p  = 1.00) and a fixed‐effects model was applied. The analysis revealed that the incidence of wound infection was significantly lower in patients who received operating room nursing interventions compared with routine nursing (1.17% vs. 5.44%, OR: 0.30, 95%CI: 0.15–0.58, p  = 0.0004), suggesting that operating room nursing is effective in preventing postoperative wound infection in ovarian cysts (Figure  3 ). The forest plots of wound infection. The occurrence of complications was reported in 15 RCTs. There were 599 cases in the operating room nursing group, of which 38 had complications, and 588 cases in the routine nursing group, of which 148 had complications. No significant heterogeneity was found ( I 2  = 0%, p  = 1.00) and a fixed‐effects model was applied. The analysis revealed the incidence of postoperative complications was significantly lower in patients who received operating room nursing interventions compared with routine nursing (6.34% vs. 25.17%, OR: 0.20, 95%CI: 0.13–0.29, p  < 0.00001), suggesting that operating room nursing was able to reduce the incidence of postoperative complications (Figure  4 ). The forest plots of postoperative complications. Hospital length of stay was reported in 12 RCTs. Four hundred and sixty nine and 467 patients in the operating room nursing and the routine nursing groups, respectively. Significant heterogeneity was found ( I 2  = 93%, p  < 0.00001), and the results were not significantly altered by sensitivity analyses, thus a random‐effects model was applied. The analysis revealed that patients who received operating room nursing intervention had a significantly shorter hospital length of stay (SMD: −3.93, 95%CI: −5.67 to −2.20, p  < 0.00001) compared with routine nursing, suggesting that operating room nursing is better able to aid in recovery and shorten the hospital length of stay (Figure  5 ). The forest plots of the hospital length of stay. Seven RCTs reported operative time. Two hundred and ninety one and 282 patients in the operating room nursing and the routine nursing groups, respectively. Significant heterogeneity was found ( I 2  = 98%, p  < 0.00001), and the results were not significantly altered by sensitivity analyses, thus a random‐effects model was applied. The analysis revealed that patients who received operating room nursing interventions had significantly shorter operative time (SMD: −2.54, 95%CI: −3.19 to −1.89, p  < 0.00001) compared with routine nursing, suggesting that operating room nursing is more effective in improving efficiency of surgery and shortening operative time (Figure  6 ). Five RCTs reported patient gastrointestinal recovery time. One hundred and seventy seven and 167 patients were in the operating room nursing and the routine nursing groups, respectively. Significant heterogeneity was found ( I 2  = 84%, p  < 0.00001), and the results were not significantly altered after sensitivity analyses, thus a random‐effects model was applied. The analysis revealed a shorter gastrointestinal recovery time in patients who received operating room nursing interventions compared to routine nursing (SMD: −1.61, 95%CI: −2.24 to −0.98, p  < 0.00001), suggesting that operating room nursing can help the recovery of gastrointestinal function in patients (Figure  7 ). The forest plots of the operative time. The forest plots of the recovery time of gastrointestinal function. We assessed publication bias by plotting a funnel plot of wound infection, and the results, as shown in Figure  8 , are essentially symmetrical on both sides of the funnel plot, indicating that there is no significant publication bias. Funnel plot for publication bias of wound infection.

Ovarian cysts are a common gynaecological condition and women of reproductive age are prone to this disease. 24 , 25 The disadvantages of traditional open surgery for removal of ovarian cysts, such as high trauma, slow healing of the incision after surgery, high incidence of postoperative complications and poor prognosis, have been gradually replaced by laparoscopic surgery. Laparoscopic surgery can enhance the patient's surgical treatment with less invasiveness and faster postoperative recovery. 26 With the improvement of the professional and technical level of surgeons and the introduction of new technologies and projects, the clinical requirements for the care of patients undergoing surgery have become higher and higher, and the normalised care approach is obviously unable to meet the clinical needs. 7 In order to achieve a sustained improvement in the quality of medical services, not only do we need to continuously improve the mode of care in the operating theatre, but we also need to put forward higher requirements for the professionalism and working ability of the nursing staff in the operating theatre. 27 Nursing interventions in the operating room are more personalised, standardised, and holistic in the care of surgical patients. Studies have shown that operating room nursing intervention has an irreplaceable role for patients undergoing surgical treatment, which not only ensures the level and quality of surgery, but also avoids the adverse effects of various emergencies and adverse factors on patients. 28 A total of 15 studies were included, and the results showed that operating room nursing interventions were effective in preventing the occurrence of postoperative wound infections and complications in ovarian cysts, shortening the operative time, patient's gastrointestinal recovery time and hospital length of stay. Yao et al.'s study of 70 patients who underwent laparoscopic ovarian cystectomy found that the operating room nursing care given to the patients could shorten operative time, hospital length of stay, reduce postoperative complications, and promote patient recovery, which consistent with our findings. 21 Liu et al.'s study of 32 patients who underwent laparoscopic ovarian cystectomy found that operating room nursing interventions could shorten postoperative gastrointestinal recovery time, reduce the incidence of complications, and shorten the hospital length of stay, which was consistent with our findings, and although this study demonstrated a positive impact on wound infections, the difference was not statistically significant, which was contrary to the results of our findings. 13 Shi et al.'s study of 58 patients undergoing surgery for ovarian cysts concluded that operating room nursing improves the rate of postoperative complications, shorten operative time and the hospital length of stay, which consistent with our findings. 9 Postoperative wound infections are not resolved by the application of antimicrobials or antibiotic analogues alone, but require the initiation of ongoing, systematic nursing care. Nursing intervention in the operating room requires nurses to communicate with patients and their families in a timely and effective manner during the nursing period to resolve their anxiety about surgery and improve the patients' cooperation in the perioperative period; during the surgical process, strictly control the environment of the operating room, surgical items and surgical personnel, strictly implement the aseptic operation of each link, and the surgeon, anaesthesiologists, visiting nurses, and instrument nurses cooperate with each other and closely monitor the patients' vital signs; send the patient back to the ward with the anaesthesiologist after the operation, and hand over to the ward nurses in time, stressing the postoperative precautions and observing the wound condition during the return visit, so as to reduce the rate of infection of the surgical incision and improve the satisfaction of nursing care. 10 , 20 Several limitations still should be addressed: (1) the included literature was all in Chinese and the study sites were all in China, which may have led to language bias; (2) the included studies included only 15 papers and most of the studies had small sample sizes; (3) there was a certain amount of bias in the implementation of different studies in operating theatre care, which may have affected the external veracity of the results to a certain extent; (4) the included literature did not mention allocation concealment and blinding leading to inadequate research methodology, which affects the credibility of the results.

In conclusion, operating room nursing interventions can significantly reduce the incidence of postoperative wound infections and complications in patients undergoing ovarian cysts surgery, and shorten operative time, gastrointestinal recovery time, and hospital length of stay. However, due to the limited amount of literature included in this study and the low quality of some of the studies, in future, more large‐scale, high‐quality studies are still needed to further validate our findings.

The ovary is not only a female reproductive organ, but also an important organ for ovulation and secretion of sex hormones, which maintains the dynamic balance of the female endocrine environment. 1 Ovarian cysts are most common in women between the ages of 20 and 50, and their causes may be related to heredity, endocrine abnormalities, lifestyle changes, and the effects of chemicals and drugs. 2 , 3 There are benign and malignant ovarian cysts, generally speaking, benign cysts do not have much effect on women's body and can be treated with medication or disappear with menstruation, while malignant cysts should be removed by surgery to alleviate various clinical symptoms. 4 The most common complication of surgery is wound infection, which refers to the redness, swelling, heat and pain of the patient's wound infection within 2–4 days after the completion of the surgery, which not only damages the function of the patient's organs, but also may endanger the patient's life in serious cases, causing irreparable damage to the patient. 5 With the continuous improvement of medical level, controlling the incidence of surgical wound infection has become the focus of attention of healthcare professionals, patients and their families, because once a patient develops a surgical wound infection, the healing time of the wound will be prolonged, which not only prolongs the hospitalisation time of the patient, but also increases the economic burden of the family, and is more likely to lead to nurse–patient and doctor‐patient disputes. 6 There are many ways to prevent postoperative wound infections, including the use of antibiotics before surgery, strict adherence to asepsis during surgery, timely dressing changes and keeping the wound dry after surgery, but the results are not particularly satisfactory, so it is particularly important to find a more appropriate way to prevent postoperative infections. Normally, care during surgery is carried out in accordance with the norm, that is, caregivers collaborate with the doctor's instructions. The care is passive, and thus the value of care needs to be improved. 7 , 8 The operating room nursing is a nursing model specially developed for the perioperative period, which emphasises patient‐centeredness, and the entire nursing care is based on the needs of the patients, so that the patients can receive friendly care during the operation, which is conducive to the alleviation of unfamiliarity, nervousness, and uneasiness. 9 At the same time, in the operating room nursing care nursing staff can also clear division of labour, do a good job in the operation of the preparation of various matters and hidden trouble detection work, the development of the surgical process is more promotional, conducive to enhance the effect of the operation, the value of nursing is very high. It has been found that the implementation of effective operating room nursing interventions in clinical practice has a positive effect on improving the prognosis of patients. 10 The impact of operating room nursing care on ovarian cyst surgery has been reported in the literature, but there is no uniform conclusion on the impact of surgical wound infection. Therefore, we conducted this study aimed evaluating the impact of operating room nursing interventions on ovarian cyst wound infections by means of meta‐analysis, with a view to providing evidence‐based medical evidence for the care of ovarian cysts in the postoperative period.

The authors declare that there is no conflict of interest.

A computer system was used to search PubMed, Web of Science, EMBASE, Cochrane Library, Wanfang, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure databases, from database inception to October 2023, for randomised controlled trials (RCTs) on the application of operating room nursing intervention to ovarian cyst surgery, and the search formula was (operating room nursing OR nursing management of operating room OR nursing of operating room). Relevant literature needed for this study was further supplemented through inclusion of references or other sources of reviews and meta‐analyses to avoid omission. Inclusion criteria: (1) study design: RCTs with content involving the application of operating room nursing to ovarian cyst surgery; (2) participants: patients who underwent ovarian cyst surgery; (3) intervention: the control group receiving routine nursing interventions, and the experimental group receiving the operating room nursing interventions; and (4) outcomes: wound infection complications, hospital length of stay, operating time, and the recovery time of gastrointestinal function. Exclusion criteria: (1) non‐RCTs; (2) duplicate literature; (3) literature with incomplete, unclear, or erroneous data; and (4) studies that included non‐laparoscopic ovarian cystectomy in the study population. Literature was screened for inclusion and exclusion criteria by two investigators who independently browsed the title and abstract in a mutually blinded format, and final confirmation of inclusion was made before extracting the following information using a uniform form: basic information (first author and year of publication), baseline status of the study population (sample size, age, duration of the disease, and size of the cysts), and outcome indicators. The literature was assessed for risk of bias using the bias risk assessment criteria provided by the Cochrane 5.1.0 Handbook. Seven items including random sequence generation, allocation concealment, blinding of subjects and personnel, blinding of outcome assessment, incomplete outcome bias, selection of outcome reports, and other biases were rated as ‘low’, ‘high’ or ‘unclear’. When disagreements arose, they were promptly discussed or resolved with a third researcher. RevMan 5.4 software was applied for data analysis. Count data were expressed as odds ratio (OR) and its 95% confidence interval (95%CI), and measurement data were expressed as standardised mean difference (SMD) and its 95%CI. Heterogeneity was analysed using I 2 and χ 2 tests; when p  > 0.05 and I 2  < 50%, a fixed‐effects model was applied; otherwise, a random‐effects model was applied. The robustness of the results was determined by excluding single studies one by one. If more than 10 studies were included, potential publication bias was assessed by funnel plot.