Shin Kyun-Ho, Kim Jin-Uk, Jang Il-Tae, Han Seung-Beom, Kim Sang-Bum
Department of Orthopedic Surgery, Incheon Nanoori Hospital, 156 Janje-ro, Bupyeong-gu, 21353 Incheon, South Korea.
Department of Neurosurgery, Gangnam Nanoori Hospital, Seoul, South Korea.
Indian J Orthop. 2022 Dec 10;57(2):211-226. doi: 10.1007/s43465-022-00794-2. eCollection 2023 Feb.
Comorbid chronic obstructive pulmonary disease (COPD) is increasingly common and may have an adverse impact on outcomes in patients undergoing total joint arthroplasty (TJA) of lower extremity. The purpose of this meta-analysis is to compare the postoperative complications between COPD and non-COPD patients undergoing primary TJA including total hip and knee arthroplasty.
PubMed, EMBASE, and Cochrane Library were systematically searched for relevant studies published before December 2021. Postoperative outcomes were compared between patients with COPD versus those without COPD as controls. The outcomes were mortality, re-admission, pulmonary, cardiac, renal, thromboembolic complications, surgical site infection (SSI), periprosthetic joint infection (PJI), and sepsis.
A total of 1,002,779 patients from nine studies were finally included in this meta-analysis. Patients with COPD had an increased risk of mortality (OR [odds ratio] = 1.69, 95% confidence interval [CI] 1.42-2.02), re-admission (OR = 1.54, 95% CI 1.38-1.71), pulmonary complications (OR = 2.73, 95% CI 2.26-3.30), cardiac complications (OR = 1.40, 95% CI 1.15-1.69), thromboembolic complications (OR = 1.21, 95% CI 1.15-1.28), renal complications (OR = 1.50, 95% CI 1.14-1.26), SSI (OR = 1.23, 95% CI 1.18-1.30), PJI (OR = 1.26, 95% CI 1.15-1.38), and sepsis (OR = 1.36, 95% CI 1.22-1.52).
Patients with comorbid COPD showed an increased risk of mortality and postoperative complications following TJA compared with patients without COPD. Therefore, orthopedic surgeons can use the study to adequately educate these potential complications when obtaining informed consent. Furthermore, preoperative evaluation and medical optimization are crucial to minimizing postoperative complications from arising in this difficult-to-treat population.
Level III.
None.
The online version contains supplementary material available at 10.1007/s43465-022-00794-2.
合并慢性阻塞性肺疾病（COPD）日益常见，可能对接受下肢全关节置换术（TJA）的患者的预后产生不利影响。本荟萃分析的目的是比较接受初次TJA（包括全髋关节和膝关节置换术）的COPD患者和非COPD患者的术后并发症。
系统检索了PubMed、EMBASE和Cochrane图书馆中2021年12月之前发表的相关研究。比较了COPD患者与无COPD作为对照的患者的术后结局。结局指标为死亡率、再次入院率、肺部、心脏、肾脏、血栓栓塞并发症、手术部位感染（SSI）、假体周围关节感染（PJI）和脓毒症。
本荟萃分析最终纳入了来自9项研究的1,002,779例患者。COPD患者的死亡风险（比值比[OR]=1.69，95%置信区间[CI]1.42-2.02）、再次入院风险（OR=1.54，95%CI 1.38-1.71）、肺部并发症风险（OR=2.73，95%CI 2.26-3.30）、心脏并发症风险（OR=1.40，95%CI 1.15-1.69）、血栓栓塞并发症风险（OR=1.21，95%CI 1.15-1.28）、肾脏并发症风险（OR=1.50，95%CI 1.14-1.26）、SSI（OR=1.23，95%CI 1.18-1.30）、PJI（OR=1.26，95%CI 1.15-1.38）和脓毒症风险（OR=1.36，95%CI 1.22-1.52）均增加。
与无COPD的患者相比，合并COPD的患者在TJA后死亡风险和术后并发症风险增加。因此，骨科医生在获取知情同意时可以利用本研究充分告知这些潜在并发症。此外，术前评估和医疗优化对于使这一难以治疗的人群术后并发症降至最低至关重要。
三级。
无。
在线版本包含可在10.1007/s43465-022-00794-2获取的补充材料。
