Guofeng Cui, Chen Yue, Rong Wei, Ruiyu Liu, Kunzheng Wang
Department of Orthopedics, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China; Department of Orthopedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Luoyang, China.
Bone Joint Res. 2020 May 16;9(3):120-129. doi: 10.1302/2046-3758.93.BJR-2019-0138.R1. eCollection 2020 Mar.
Patients with metabolic syndrome (MetS) are known to be at increased risk of postoperative complications, but it is unclear whether MetS is also associated with complications after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Here, we perform a systematic review and meta-analysis linking MetS to postoperative complications in THA and TKA.
The PubMed, OVID, and ScienceDirect databases were comprehensively searched and studies were selected and analyzed according to the guidelines of the Meta-analysis of Observational Studies in Epidemiology (MOOSE). We assessed the methodological quality of each study using the Newcastle-Ottawa Scale (NOS), and we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were extracted and meta-analyzed or qualitatively synthesized for several outcomes.
Ten cohort studies involving 1,352,685 patients were included. Qualitative analysis suggested that MetS was associated with a higher incidence of cardiovascular events, and meta-analysis showed that MetS increased the risk of all-cause complications (risk ratio (RR) 1.55, 95% confidence interval (CI) 1.28 to 1.89), surgical site infection (SSI; RR 2.99, 95% CI 1.30 to 6.90), urinary tract infection (UTI; RR 2.58, 95% CI 1.03 to 6.43), and 30-day readmission (RR 1.45, 95% CI 1.33 to 1.59). There was insufficient evidence for assessing an association between MetS and venous thromboembolism events, pulmonary or gastrointestinal complications, or mortality.
Patients with MetS undergoing THA and TKA are at increased risk of all-cause complications, cardiovascular complications, SSI, UTI, and 30-day readmission. Surgeons should be aware of the increased risk of these complications in MetS, and presurgical protocols for these complications should give special consideration to MetS patients. 2020;9(3):120-129.
已知代谢综合征（MetS）患者术后并发症风险增加，但尚不清楚MetS是否也与全髋关节置换术（THA）或全膝关节置换术（TKA）后的并发症相关。在此，我们进行了一项系统评价和荟萃分析，将MetS与THA和TKA术后并发症联系起来。
全面检索了PubMed、OVID和ScienceDirect数据库，并根据流行病学观察性研究的荟萃分析（MOOSE）指南选择和分析研究。我们使用纽卡斯尔-渥太华量表（NOS）评估每项研究的方法学质量，并使用推荐分级评估、制定和评价（GRADE）评估证据质量。提取数据并对几个结局进行荟萃分析或定性综合。
纳入了10项队列研究，涉及1,352,685例患者。定性分析表明，MetS与心血管事件的发生率较高相关，荟萃分析表明，MetS增加了全因并发症（风险比（RR）1.55，95%置信区间（CI）1.28至1.89）、手术部位感染（SSI；RR 2.99，95%CI 1.30至6.90）、尿路感染（UTI；RR 2.58，95%CI 1.03至6.43）和30天再入院（RR 1.45，95%CI 1.33至1.59）的风险。评估MetS与静脉血栓栓塞事件、肺部或胃肠道并发症或死亡率之间关联的证据不足。
接受THA和TKA的MetS患者全因并发症、心血管并发症、SSI、UTI和30天再入院的风险增加。外科医生应意识到MetS患者这些并发症的风险增加，并且针对这些并发症的术前方案应特别考虑MetS患者。2020；9(3):120 - 129。
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