Zorrilla-Vaca Andres, Grant Michael C, Mathur Vineesh, Li Jinlei, Wu Christopher L
From the *Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD; †Faculty of Health, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia; and ‡Department of Anesthesiology, Yale University, New Haven, CT.
Reg Anesth Pain Med. 2016 Sep-Oct;41(5):555-63. doi: 10.1097/AAP.0000000000000437.
Recent studies have yielded conflicting results on the association between anesthesia technique and incidence of postoperative surgical site infections (SSIs) after knee arthroplasty (KA) and hip arthroplasty (HA). Our group conducted a meta-analysis of all available studies to clarify this potential association.
Our group searched MEDLINE, EMBASE, and Google Scholar for all relevant studies (1990-2015) reporting on the association between anesthetic technique and SSI after KA or HA. Meta-analysis was performed to estimate both the pooled unadjusted odds ratio (OR) and adjusted OR (aOR) using a random-effects model. Subgroup analyses and metaregression were conducted to explore potential sources of heterogeneity and bias.
Of the initial 435 records, 13 studies (n = 362,029) met the inclusion criteria. The use of neuraxial anesthesia was associated with a significant reduction in incidence of postoperative SSI as compared with general anesthesia for all arthroplasties based on unadjusted (OR, 0.77; 95% confidence interval [CI], 0.70-0.86; P < 0.001) and adjusted (aOR = 0.84; 95% CI, 0.76-0.92; P < 0.001) data. Subgroup analyses showed similar reductions in incidence of postoperative SSI for KA (OR = 0.75; 95% CI, 0.68-0.84; P < 0.001; aOR = 0.85; 95% CI, 0.79-0.92; P < 0.001) and HA (OR = 0.79; 95% CI, 0.65 to 0.95; P = 0.02; aOR = 0.84; 95% CI, 0.71-1.00; P = 0.057).
Synthesis of the existing evidence supports the overall beneficial effects of neuraxial anesthesia in decreasing the development of SSI after joint arthroplasty (KA and HA). Given the limitations associated with interpretation of data from large observational trials, further investigation using prospective randomized trial design is warranted in this promising area.
近期研究对于麻醉技术与膝关节置换术（KA）和髋关节置换术（HA）后手术部位感染（SSI）发生率之间的关联得出了相互矛盾的结果。我们团队对所有可得研究进行了荟萃分析，以阐明这种潜在关联。
我们团队在MEDLINE、EMBASE和谷歌学术中检索了所有相关研究（1990 - 2015年），这些研究报告了麻醉技术与KA或HA后SSI之间的关联。采用随机效应模型进行荟萃分析，以估计合并的未调整比值比（OR）和调整后的OR（aOR）。进行亚组分析和元回归以探索异质性和偏倚的潜在来源。
在最初的435条记录中，13项研究（n = 362,029）符合纳入标准。基于未调整（OR，0.77；95%置信区间[CI]，0.70 - 0.86；P < 0.001）和调整后（aOR = 0.84；95% CI，0.76 - 0.92；P < 0.001）的数据，与全身麻醉相比，对于所有关节置换术，使用椎管内麻醉与术后SSI发生率显著降低相关。亚组分析显示，KA（OR = 0.75；95% CI，0.68 - 0.84；P < 0.001；aOR = 0.85；95% CI，0.79 - 0.92；P < 0.001）和HA（OR = 0.79；95% CI，0.65至0.95；P = 0.02；aOR = 0.84；95% CI，0.71 - 1.00；P = 0.057）术后SSI发生率也有类似程度的降低。
现有证据的综合支持了椎管内麻醉在降低关节置换术（KA和HA）后SSI发生方面的总体有益作用。鉴于对大型观察性试验数据解释存在的局限性，在这个有前景的领域有必要采用前瞻性随机试验设计进行进一步研究。
