First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.
Department of Orthopedics, University of Ioannina, School of Medicine, University Hospital of Ioannina, Ioannina, Greece.
J Hosp Infect. 2019 Sep;103(1):69-77. doi: 10.1016/j.jhin.2019.04.020. Epub 2019 May 3.
A growing body of evidence associates malnutrition with several adverse outcomes.
To investigate the link between malnutrition with surgical site and periprosthetic joint infections (SSIs and PJIs) following total knee and hip arthroplasty (TKA and THA) through a comprehensive meta-analysis of observational studies.
A systematic search was conducted on PubMed and Scopus databases through December 2018, and recent proceedings of major orthopaedic meetings. Data from eligible studies were extracted and synthesized; pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated.
Seven publications were included, reporting eight independent cohort studies with >250,000 subjects. SSIs and PJIs were more likely to develop in malnourished patients (OR: 2.49; 95% CI: 2.13-2.90; and 3.62; 2.33-5.64, respectively). The association of SSI with malnutrition was evident both after TKA (2.42; 1.94-3.02) and after THA (2.66; 1.64-4.30). Similarly, PJI was associated with malnutrition after TKA (2.55; 1.10-5.91) and after THA (3.10; 1.84-5.25). Finally, PJI correlated with malnutrition both after primary arthroplasty (3.58; 1.82-7.03) and revision arthroplasty (3.96; 2.47-6.33). The subgroup analysis by study setting confirmed the relationship between PJI and malnutrition in hospital (6.02; 3.07-11.81) and population-based (2.80; 1.76-4.44) studies.
Malnutrition is associated with PJIs and SSIs after total joint arthroplasty. Further high-quality research is warranted to confirm or refute these findings.
越来越多的证据表明营养不良与多种不良结局有关。
通过对观察性研究的综合荟萃分析，研究营养不良与全膝关节和髋关节置换术后手术部位和假体周围关节感染（SSI 和 PJI）之间的关系。
对 PubMed 和 Scopus 数据库进行系统检索，检索时间截至 2018 年 12 月，并检索了主要骨科会议的最新会议记录。提取并综合合格研究的数据；估计合并优势比（OR）及其 95%置信区间（CI）。
纳入 7 篇文献，报道了 8 项独立的队列研究，涉及超过 25 万名患者。营养不良患者更有可能发生 SSI 和 PJI（OR：2.49；95%CI：2.13-2.90；3.62；2.33-5.64）。营养不良与 TKA 后（2.42；1.94-3.02）和 THA 后（2.66；1.64-4.30）的 SSI 之间存在明显关联。同样，TKA 后（2.55；1.10-5.91）和 THA 后（3.10；1.84-5.25）的 PJI 也与营养不良有关。最后，原发关节置换术后（3.58；1.82-7.03）和翻修关节置换术后（3.96；2.47-6.33）的 PJI 也与营养不良有关。按研究地点进行的亚组分析证实了 PJI 与医院（6.02；3.07-11.81）和人群（2.80；1.76-4.44）研究中 PJI 和营养不良之间的关系。
营养不良与全关节置换术后的 PJI 和 SSI 有关。需要进一步进行高质量的研究来证实或反驳这些发现。
