Guerado Enrique, Cano Juan Ramon, Pons-Palliser Joana
Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Malaga, Marbella, Spain.
Medical Library, Hospital Universitario Costa del Sol, University of Malaga, Marbella, Spain.
Bone Joint Res. 2020 Dec;9(12):884-893. doi: 10.1302/2046-3758.912.BJR-2019-0045.R4.
A systematic literature review focusing on how long before surgery concurrent viral or bacterial infections (respiratory and urinary infections) should be treated in hip fracture patients, and if there is evidence for delaying this surgery.
A total of 11 databases were examined using the COre, Standard, Ideal (COSI) protocol. Bibliographic searches (no chronological or linguistic restriction) were conducted using, among other methods, the Patient, Intervention, Comparison, Outcome (PICO) template. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for flow diagram and checklist. Final reading of the complete texts was conducted in English, French, and Spanish. Classification of papers was completed within five levels of evidence (LE).
There were a total of 621 hits (526 COre; 95 Standard, Ideal) for screening identification, and 107 records were screened. Overall 67 full-text articles were assessed for eligibility, and 21 articles were included for the study question. A total of 46 full-text articles were excluded with reasons. No studies could be included in quantitative synthesis (meta-analyses), and there were many confounding variables including surgeons' experience, prosthesis models used, and surgical technique.
Patients with hip fracture and with a viral infection in the upper respiratory tract or without major clinical symptoms should be operated on as soon as possible (LE: I-III). There is no evidence that patients with coronavirus disease 2019 (COVID-19) should be treated differently. In relation to pneumonia, its prevention is a major issue. Antibiotics should be administered if surgery is delayed by > 72 hours or if bacterial infection is present in the lower respiratory tract (LE: III-V). In patients with hip fracture and urinary tract infection (UTI), delaying surgery may provoke further complications (LE: I). However, diabetic or immunocompromised patients may benefit from immediate antibiotic treatment. Cite this article: 2020;9(12):884-893.
进行一项系统的文献综述，重点关注髋部骨折患者并发病毒或细菌感染（呼吸道和泌尿道感染）在手术前应治疗多长时间，以及是否有证据支持延迟手术。
使用核心、标准、理想（COSI）方案对总共11个数据库进行了检查。除其他方法外，还使用患者、干预措施、对照、结局（PICO）模板进行了文献检索（无时间或语言限制）。我们遵循系统评价和Meta分析的首选报告项目（PRISMA）指南绘制流程图并填写清单。对完整文本的最终阅读以英语、法语和西班牙语进行。论文分类在五级证据（LE）范围内完成。
总共筛选出621条命中记录（526条核心记录；95条标准、理想记录）用于筛选识别，共筛选了107条记录。总体而言，对67篇全文进行了资格评估，21篇文章被纳入研究问题。共有46篇全文因各种原因被排除。没有研究可纳入定量合成（Meta分析），并且存在许多混杂变量，包括外科医生的经验、使用的假体模型和手术技术。
髋部骨折且上呼吸道有病毒感染或无重大临床症状的患者应尽快手术（证据级别：I-III）。没有证据表明2019冠状病毒病（COVID-19）患者应区别对待。对于肺炎，预防是一个主要问题。如果手术延迟超过72小时或下呼吸道存在细菌感染，应使用抗生素（证据级别：III-V）。对于髋部骨折和尿路感染（UTI）患者，延迟手术可能会引发更多并发症（证据级别：I）。然而，糖尿病或免疫功能低下的患者可能从立即使用抗生素治疗中获益。引用本文：2020；9（12）：884-893。
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