Sharma Siddhartha, John Rakesh, Patel Sandeep, Neradi Deepak, Kishore Kamal, Dhillon Mandeep S
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Department of Orthopaedics, Hull and Yorkshire Royal Infirmary, Hull, United Kingdom.
J Clin Orthop Trauma. 2021 Jun;17:239-253. doi: 10.1016/j.jcot.2021.03.016. Epub 2021 Mar 28.
Orthopedic surgical procedures (OSPs) are known to generate bioaerosols, which could result in transmission of infectious diseases. Hence, this review was undertaken to analyse the available evidence on bioaerosols in OSPs, and their significance in COVID-19 transmission.
A systematic review was conducted by searching the PubMed, EMBASE, Scopus, Cochrane Library, medRxiv, bioRxiv and Lancet preprint databases for studies on bioaerosols in OSPs. Random-effects metanalysis was conducted to determine pooled estimates of key bioaerosol characteristics. Risk of bias was assessed by the RoB-SPEO tool; overall strength of evidence was assessed by the GRADE approach.
17 studies were included in the systematic review, and 6 in different sets of meta-analyses. The pooled estimate of particle density was 390.74 μg/m, Total Particle Count, 6.08 × 10/m, and Microbial Air Contamination, 8.08 CFU/m. Small sized particles (</ = 0.5 μm) were found to be 37 and 1604 times more frequent in the aerosol cloud in comparison to medium and large sized particles respectively. 4 studies reported that haemoglobin could be detected in aerosols, and one study showed that HIV could be transmitted by blood aerosolized by electric saw and burr. The risk of bias for all studies in the review was determined to be high, and the quality of evidence, low.
Whereas there is evidence to suggest that OSPs generate large amounts of bioaerosols, their potential to transmit infectious diseases like COVID-19 is questionable. High-quality research, as well as consensus minimum reporting guidelines for bioaerosol research in OSPs is the need of the hour.
已知骨科手术操作（OSPs）会产生生物气溶胶，这可能导致传染病传播。因此，进行本综述以分析关于骨科手术操作中生物气溶胶的现有证据及其在新冠病毒传播中的意义。
通过检索PubMed、EMBASE、Scopus、Cochrane图书馆、medRxiv、bioRxiv和《柳叶刀》预印本数据库，对骨科手术操作中生物气溶胶的研究进行系统综述。采用随机效应荟萃分析来确定关键生物气溶胶特征的合并估计值。使用RoB-SPEO工具评估偏倚风险；采用GRADE方法评估证据的总体强度。
系统综述纳入了17项研究，不同组的荟萃分析纳入了6项研究。颗粒密度的合并估计值为390.74μg/m，总颗粒计数为6.08×10/m，微生物空气污染为8.08CFU/m。发现小尺寸颗粒（≤0.5μm）在气溶胶云中出现的频率分别比中尺寸和大尺寸颗粒高37倍和1604倍。4项研究报告称气溶胶中可检测到血红蛋白，1项研究表明艾滋病毒可通过电锯和磨钻雾化的血液传播。综述中所有研究的偏倚风险被确定为高，证据质量低。
虽然有证据表明骨科手术操作会产生大量生物气溶胶，但它们传播新冠病毒等传染病的可能性存疑。目前亟需高质量研究以及骨科手术操作中生物气溶胶研究的共识性最低报告指南。
