Li Zhizhuo, Xu Xingquan, Zhuang Zaikai, Lu Jun, Gao Fuqiang, Jiang Qing
State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Department of Orthopedics, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
Int Wound J. 2024 Jan;21(1):e14369. doi: 10.1111/iwj.14369. Epub 2023 Aug 30.
Postoperative Surgical Site Infections (SSIs) pose significant challenges to recovery after joint arthroplasty. This systematic review and meta-analysis aim to compare the incidence of SSIs after knee or hip arthroplasty under Spinal Anaesthesia (SA) versus general anaesthesia (GA). We conducted the systematic review and meta-analysis following the PRISMA guidelines, analysing data from 15 studies selected from PubMed, Embase, Web of Science, and Cochrane Library up to May 16, 2023. The analysis included studies comparing SSIs incidence in patients aged 18 years and above who underwent knee or hip arthroplasty under SA or GA. Quality assessment was performed using the Cochrane Collaboration's risk of bias tool. The effect size was calculated using random or fixed-effects models based on the observed heterogeneity. We assessed the heterogeneity between studies and conducted a sensitivity analysis. Of 1651 initially identified studies, 15 articles encompassing 353 169 patients were included in the final analysis. A total of 156 405 patients were under SA, while 196 764 received GA. The studies demonstrated substantial heterogeneity (p = 0.007, I = 53.7%), resulting in a random-effects model being employed. Patients receiving SA showed a 23% lower likelihood of developing SSIs postoperatively compared to GA patients (OR: 0.77, 95% CI: 0.70-0.86, p < 0.001). Sub-group analysis further confirmed these findings regardless of the type of joint arthroplasty. This meta-analysis indicated a significantly lower incidence of SSIs following knee or hip arthroplasty under SA compared to GA. Despite observed heterogeneity, the results underscore the potential benefit of SA over GA in orthopaedic surgeries to reduce the risk of SSIs.
术后手术部位感染（SSIs）对关节置换术后的恢复构成重大挑战。本系统评价和荟萃分析旨在比较脊髓麻醉（SA）与全身麻醉（GA）下膝关节或髋关节置换术后SSIs的发生率。我们按照PRISMA指南进行了系统评价和荟萃分析，分析了截至2023年5月16日从PubMed、Embase、科学网和Cochrane图书馆中选出的15项研究的数据。该分析纳入了比较18岁及以上接受SA或GA下膝关节或髋关节置换术患者的SSIs发生率的研究。使用Cochrane协作偏倚风险工具进行质量评估。根据观察到的异质性，使用随机或固定效应模型计算效应量。我们评估了研究之间的异质性并进行了敏感性分析。在最初确定的1651项研究中，最终分析纳入了15篇文章，涵盖353169名患者。共有156405名患者接受SA，而196764名患者接受GA。研究显示存在显著异质性（p = 0.007，I² = 53.7%），因此采用随机效应模型。与接受GA的患者相比，接受SA的患者术后发生SSIs的可能性低23%（OR：0.77，95%CI：0.70 - 0.86，p < 0.001）。亚组分析进一步证实了这些发现，无论关节置换术的类型如何。这项荟萃分析表明，与GA相比，SA下膝关节或髋关节置换术后SSIs的发生率显著更低。尽管观察到异质性，但结果强调了在骨科手术中SA相对于GA在降低SSIs风险方面的潜在益处。
