Cheng Tao, Li Guoyong, Ning Huiming, Hao Liang
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, The People's Republic of China.
Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Nanchang University, Nanchang, The People's Republic of China; Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, The People's Republic of China.
J Arthroplasty. 2023 Feb;38(2):300-306. doi: 10.1016/j.arth.2022.08.005. Epub 2022 Aug 11.
Previous studies have shown that chronic hepatitis B virus (HBV) infection may place patients at increased risk of postoperative adverse events. However, there is limited information on the effects of antiviral treatment (AVT) on postoperative outcomes following total hip arthroplasties (THAs).
A multicenter retrospective database query was used to identify patients infected with HBV undergoing THAs between 2012 and 2017. All eligible patients were divided into 2 cohorts on the basis of AVT before surgery: the treated group and the untreated group. The treated cohort was matched at a ratio of 1:3 to the untreated cohort by propensity score matching. Operating times, blood losses, all-type complications, surgical complications, lengths of stay, 90-day readmissions, unplanned reoperations, and implant revisions were compared between the 2 cohorts. After these patients were further stratified by liver fibrosis status, multivariate logistic analyses were performed by controlling for differences in demographics and comorbidities. In total, 918 patients chronically infected with HBV were identified. Over four-fifths of these patients (83.0%) did not receive preoperative AVT. Of interest, more than half of the untreated patients (54.1%) were previously undiagnosed.
The untreated group had significantly longer mean operating time (82 versus 76 minutes, P = .007) and higher mean blood loss (515 versus 465 mL, P = .03) than the treated group. Moreover, they were more prone to experiencing surgical complications (25.4% versus 16.7%, P = .01), longer lengths of stay (6.2 versus 5.4 days, P = .0005), readmissions (12.4% versus 5.8%, P = .02), reoperations (16.7% versus 9.6%, P = .03), and revisions (11.1% versus 4.5%, P = .02). Multivariate regression analyses found that AVT significantly decreased all-type complications, reoperations, and revisions in patients with significant fibrosis (all P < .05).
The AVT of HBV infection prior to THAs could reduce the risk of developing postoperative complications, regardless of the presence of liver fibrosis. This finding emphasizes that surgeons should recommend HBV screening and treatment integrated into preoperative medical optimization.
既往研究表明，慢性乙型肝炎病毒（HBV）感染可能会增加患者术后发生不良事件的风险。然而，关于抗病毒治疗（AVT）对全髋关节置换术（THA）术后结局影响的信息有限。
采用多中心回顾性数据库查询，以确定2012年至2017年间接受THA的HBV感染患者。所有符合条件的患者根据术前是否接受AVT分为2组：治疗组和未治疗组。通过倾向评分匹配，将治疗组与未治疗组按1:3的比例进行匹配。比较两组患者的手术时间、失血量、各类并发症、手术并发症、住院时间、90天再入院率、计划外再次手术率和植入物翻修率。在根据肝纤维化状态对这些患者进行进一步分层后，通过控制人口统计学和合并症差异进行多因素逻辑分析。共识别出918例慢性HBV感染患者。其中超过五分之四（83.0%）的患者未接受术前AVT。有趣的是，超过一半（54.1%）的未治疗患者此前未被诊断。
未治疗组的平均手术时间显著长于治疗组（82分钟对76分钟，P = .007），平均失血量也更高（515毫升对465毫升，P = .03）。此外，他们更容易出现手术并发症（25.4%对16.7%，P = .01）、住院时间更长（6.2天对5.4天，P = .0005）、再入院率更高（12.4%对5.8%，P = .02）、再次手术率更高（16.7%对9.6%，P = .03）以及翻修率更高（11.1%对4.5%，P = .02）。多因素回归分析发现，AVT显著降低了显著纤维化患者的各类并发症、再次手术率和翻修率（所有P < .05）。
THA术前对HBV感染进行AVT可降低术后并发症发生风险，无论是否存在肝纤维化。这一发现强调外科医生应建议将HBV筛查和治疗纳入术前医疗优化中。
