Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, No.600 Yishan Road, Xuhui District, 200233 Shanghai, People's Republic of China.
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, No.600 Yishan Road, Xuhui District, 200233 Shanghai, People's Republic of China.
Orthop Traumatol Surg Res. 2022 Apr;108(2):102947. doi: 10.1016/j.otsr.2021.102947. Epub 2021 Apr 27.
Whether hepatitis C virus (HCV)-positive patients are at risk for increased complications and long hospital stay following total joint arthroplasty (TJA) remains unclear. Therefore we performed a meta-analysis aiming to answer the following question: (1) are there differences in postoperative complications including joint infection and mortality between patients with or without hepatitis C following TJAs? (2) Are patients without HCV be associated with less blood loss, shorter hospital stay, lower readmission rate, higher function scores, lower revision and reoperation rates than patients with HCV?
A meta-analysis was conducted to pool data and quantitatively assessing the association between HCV infection and risks for adverse postoperative outcomes. A systematic search of all published studies concerning HCV and TJA was performed in five bibliographic databases, including PubMed, EMBASE, China National Knowledge Infrastructure, Web of Science, and the Cochrane Library databases. Random-effects meta-analysis of odds ratios (OR) was accomplished according to the classification of adverse events, subgroup analyses were performed based on surgery type.
Fifteen eligible observational studies were included with a sample size of 9,788,166 patients. Overall pooled data revealed the increased risk of overall complications, including medical and surgical complications, in HCV-positive patients undergoing TJA compared with than in HCV-negative people (OR 1.57; 95%CI: 1.44-1.71 [p<0.00001]). Joint infections were highly common in HCV-positive patients undergoing lower-extremity TJA (OR 2.06; 95%CI: 1.73-2.47 [p<0.00001]). Furthermore, HCV infections were associated with high rates of reoperations and revisions (OR 1.47; 95%CI: 1.40-1.55 [p<0.00001]).
Patients with hepatitis C have an increased risk of adverse outcomes post-TJA and a high risk of reoperation and revision that is partially attributed to postoperative complications, particularly joint infections.
III; systematic review and meta-analysis.
丙型肝炎病毒（HCV）阳性患者在接受全关节置换术后（TJA）是否会增加并发症和延长住院时间尚不清楚。因此，我们进行了一项荟萃分析，旨在回答以下问题：（1）在 TJA 后，患有或不患有丙型肝炎的患者在术后并发症（包括关节感染和死亡率）方面是否存在差异？（2）与患有 HCV 的患者相比，不患有 HCV 的患者是否与更少的失血量、更短的住院时间、更低的再入院率、更高的功能评分、更低的翻修和再手术率相关？
进行荟萃分析以汇总数据并定量评估 HCV 感染与不良术后结局风险之间的关系。在五个文献数据库（包括 PubMed、EMBASE、中国国家知识基础设施、Web of Science 和 Cochrane Library 数据库）中对所有关于 HCV 和 TJA 的已发表研究进行了系统检索。根据不良事件的分类，采用随机效应荟萃分析计算比值比（OR），并进行基于手术类型的亚组分析。
纳入了 15 项符合条件的观察性研究，样本量为 9788166 例患者。总体汇总数据显示，与 HCV 阴性患者相比，接受 TJA 的 HCV 阳性患者的总体并发症（包括医疗和手术并发症）风险增加（OR 1.57；95%CI：1.44-1.71 [p<0.00001]）。HCV 阳性患者行下肢 TJA 时关节感染非常常见（OR 2.06；95%CI：1.73-2.47 [p<0.00001]）。此外，HCV 感染与高再手术和翻修率相关（OR 1.47；95%CI：1.40-1.55 [p<0.00001]）。
丙型肝炎患者在接受 TJA 后发生不良结局的风险增加，再手术和翻修的风险很高，这部分归因于术后并发症，尤其是关节感染。
III；系统评价和荟萃分析。
