同时存在营养不良和衰弱是二期翻修治疗慢性假体周围关节感染后不良结局的重要危险因素。
Concomitant malnutrition and frailty are significant risk factors for poor outcome following two-stage revision for chronic periprosthetic joint infection.
机构信息
Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 086-350001, China.
Department of Rehabilitation Therapy, Jiangsu Rongjun Hospital, Wuxi, 214000, Jiangsu, China.
出版信息
J Orthop Surg Res. 2023 Oct 27;18(1):804. doi: 10.1186/s13018-023-04293-4.
BACKGROUND
Two-stage revision remains the gold standard for periprosthetic joint infection (PJI) treatment. Although previous studies have examined malnutrition and frailty independently, their cumulative effects are not clear. Therefore, this study aimed to assess the individual and combined influence of malnutrition and frailty on the two-stage revision surgery.
METHODS
Patients with chronic PJI undergoing two-stage revision were retrospectively included. The definition of PJI is completely consistent with the evidence-based definition of PJI recorded by the MSIS in 2018. Preoperative serum albumin levels and 11-item modified frailty index scores were collected. Four cohorts were created: (1) Normal (N), (2) Frail (F), (3) Malnourished (M), and (4) Malnourished and frail (MF). Demographic data, comorbidities, and postoperative complications were collected and compared between the four cohorts.
RESULTS
A total of 117 consecutive patients were enrolled, 48% of patients were healthy (27.4% F, 16.2% M, and 9.4% MF). MF group showed lower scores on the physical composite scale of the 12-item short-form health survey (SF12-PCS), mental composite summary (SF12-MCS), Harris hip score (HHS), and knee society score (KSS) (P < 0.05). The incidence of reinfection in the MF group was higher than that in all other groups (MF vs. N; odds ratio [OR] 3.7, 95% confidence interval [CI] 1.37 - 8.82, P = 0.032). The incidence of complications in the MF group was higher than that in all other groups (MF vs. N; OR 4.81, 95% CI 1.58-9.26, P = 0.018). Postoperative transfusion events (OR 2.92, 95% CI 1.27-3.09, P = 0.021), readmission at 60 days after the operation (OR 4.91, 95% CI 1.82-13.80, P = 0.012) was higher in the MF patients. In addition, the extended length of stay after the operation was highest in the MF patients, with an OR of 5.78 (95% CI 2.16-12.04, P = 0.003).
CONCLUSION
The concurrent presence of concomitant malnutrition and frailty in patients with PJI is related to poor prognosis and may be a predictor of the efficacy of two-stage revision. Future research will be needed to describe the benefits of improving these risk factors for patients with PJI.
背景
对于假体周围关节感染（PJI）的治疗，两阶段翻修仍然是金标准。尽管先前的研究已经分别研究了营养不良和虚弱，但它们的累积影响尚不清楚。因此，本研究旨在评估营养不良和虚弱对两阶段翻修手术的单独和联合影响。
方法
回顾性纳入接受两阶段翻修的慢性 PJI 患者。PJI 的定义完全符合 2018 年 MSIS 记录的 PJI 的循证定义。收集术前血清白蛋白水平和 11 项改良虚弱指数评分。创建了四个队列：（1）正常（N），（2）虚弱（F），（3）营养不良（M）和（4）营养不良和虚弱（MF）。收集并比较了四个队列之间的人口统计学数据、合并症和术后并发症。
结果
共纳入 117 例连续患者，其中 48%的患者健康（27.4%F、16.2%M 和 9.4%MF）。MF 组在 12 项简短健康调查的物理综合量表（SF12-PCS）、心理综合摘要（SF12-MCS）、Harris 髋关节评分（HHS）和膝关节协会评分（KSS）上的评分较低（P<0.05）。MF 组的再感染发生率高于其他所有组（MF 与 N；比值比 [OR] 3.7，95%置信区间 [CI] 1.37-8.82，P=0.032）。MF 组的并发症发生率高于其他所有组（MF 与 N；OR 4.81，95% CI 1.58-9.26，P=0.018）。术后输血事件（OR 2.92，95% CI 1.27-3.09，P=0.021）和术后 60 天再次入院（OR 4.91，95% CI 1.82-13.80，P=0.012）的发生率更高。此外，MF 患者的术后住院时间延长最长，OR 为 5.78（95% CI 2.16-12.04，P=0.003）。
结论
PJI 患者同时存在营养不良和虚弱与不良预后相关，可能是两阶段翻修疗效的预测因素。未来的研究将需要描述改善这些 PJI 患者的危险因素的益处。
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