Department of Public Health, Health Management and Policy, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan.
Can J Anaesth. 2018 Aug;65(8):893-900. doi: 10.1007/s12630-018-1139-6. Epub 2018 Apr 23.
Periprosthetic joint infection is a serious complication of total knee arthroplasty. Though there are many factors that might increase its risk, the use of propofol for maintaining general anesthesia could theoretically increase the incidence of infection because of its lipid component that supports bacterial growth. Nevertheless, the relationship between anesthetic maintenance agents and the occurrence of periprosthetic joint infection remains uncertain. The purpose of this study was to compare the incidence of suspected early-onset periprosthetic joint infection between patients undergoing total knee arthroplasty under propofol vs sevoflurane anesthesia.
We conducted a retrospective cohort study of patients in the national inpatient Diagnosis Procedure Combination database in Japan who underwent total knee arthroplasty. Suspected periprosthetic joint infection was surrogately defined as the need for arthrocentesis or debridement within 30 days of surgery. Propensity score matching was performed between patients who received either propofol or sevoflurane for anesthetic maintenance to determine the proportion of those with infection.
Eligible patients (n = 21,899) were categorized into either the propofol (n = 7,439) or sevoflurane (n = 14,460) groups. In the 5,140 propensity-matched patient pairs, there was no significant difference in the proportion of arthrocentesis or debridement [1.3% propofol vs 1.7% sevoflurane; respectively (relative risk, 0.76; 95% CI, 0.55 to 1.04; P = 0.10)] between the groups. The mean (SD) length of stay in the propofol group was significantly longer than in the sevoflurane group [32.5 (18.4) days vs 31.4 (14.4) days, respectively; mean difference, 1.1; 95% CI, 0.5 to 1.8; P < 0.001].
Propensity score analysis suggested no significant association between the choice of anesthetic maintenance agent and the occurrence of suspected early-onset periprosthetic joint infection in patients undergoing total knee arthroplasty.
人工关节周围感染是全膝关节置换术的严重并发症。虽然有许多因素可能会增加其风险，但由于丙泊酚的脂质成分支持细菌生长，因此理论上使用丙泊酚维持全身麻醉会增加感染的发生率。然而，麻醉维持剂与人工关节周围感染的发生之间的关系仍不确定。本研究的目的是比较接受丙泊酚与七氟醚麻醉的全膝关节置换术患者发生疑似早期人工关节周围感染的发生率。
我们对日本国家住院诊断程序组合数据库中接受全膝关节置换术的患者进行了回顾性队列研究。疑似人工关节周围感染被替代定义为术后 30 天内需要关节穿刺或清创术。对接受丙泊酚或七氟醚维持麻醉的患者进行倾向评分匹配，以确定感染的比例。
符合条件的患者（n=21899）分为丙泊酚组（n=7439）和七氟醚组（n=14460）。在 5140 对匹配的患者中，关节穿刺或清创术的比例在两组间无显著差异[丙泊酚组为 1.3%，七氟醚组为 1.7%；相对风险，0.76；95%可信区间，0.55 至 1.04；P=0.10]。丙泊酚组的平均（SD）住院时间明显长于七氟醚组[32.5（18.4）天比 31.4（14.4）天；平均差值，1.1；95%可信区间，0.5 至 1.8；P<0.001]。
倾向评分分析表明，在接受全膝关节置换术的患者中，麻醉维持剂的选择与疑似早期人工关节周围感染的发生之间无显著关联。
