Department of Infection Management and Disease Prevention and Control, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
Center of Biobank, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
Surgeon. 2024 Dec;22(6):e221-e229. doi: 10.1016/j.surge.2024.07.008. Epub 2024 Aug 10.
Surgical site infection (SSI) remains a critical postoperative complication after total hip and knee arthroplasty (THA and TKA). Frailty, a condition characterized by decreased physiological reserve and increased vulnerability to stressors, may influence the risk of SSI in these patients. This meta-analysis aims to evaluate the association between frailty and the incidence of SSI following THA or TKA.
A systematic search of databases including PubMed, EMBASE, Web of Science, Wanfang, and CNKI was conducted to identify relevant studies. Data were extracted and pooled using a random-effects model to calculate the overall risk ratio (RR) and 95 % confidence intervals (CIs).
A total of ten studies comprising 1,036,787 patients met the inclusion criteria. The meta-analysis revealed that frail patients undergoing THA or TKA had a significantly higher risk of developing SSI compared to non-frail patients (RR = 1.64, 95 % CI: 1.39-1.93, p < 0.001, I = 66 %). Subgroup analyses indicated that the type of arthroplasty (hip vs. knee) and the method of frailty assessment did not significantly alter the association. Further subgroup analysis suggested that frailty was significantly associated with a higher incidence of deep SSI including joint infection (RR = 1.77, 95 % CI: 1.27-1.48, p < 0.001), but not the incidence of superficial SSI (RR = 1.57, 95 % CI: 0.45-5.42, p = 0.48). The association between frailty and SSI remains in subgroup of multivariate studies only (RR = 1.56, 95 % CI: 1.34 to 1.80, p < 0.001).
Frailty is a potential predictor of SSI following TKA/THA.
手术部位感染（SSI）仍然是全髋关节和膝关节置换术（THA 和 TKA）后一个严重的术后并发症。衰弱是一种以生理储备减少和对压力源易感性增加为特征的疾病，可能会影响这些患者 SSI 的风险。本荟萃分析旨在评估衰弱与 THA 或 TKA 后 SSI 发生率之间的关系。
系统检索包括 PubMed、EMBASE、Web of Science、万方和中国知网在内的数据库，以确定相关研究。使用随机效应模型提取和汇总数据，以计算总体风险比（RR）和 95%置信区间（CI）。
共有十项研究纳入了 1036787 名患者，符合纳入标准。荟萃分析显示，接受 THA 或 TKA 的衰弱患者发生 SSI 的风险明显高于非衰弱患者（RR=1.64，95%CI：1.39-1.93，p<0.001，I²=66%）。亚组分析表明，关节置换类型（髋关节与膝关节）和衰弱评估方法并不显著改变这种关联。进一步的亚组分析表明，衰弱与深部 SSI（包括关节感染）的发生率显著相关（RR=1.77，95%CI：1.27-1.48，p<0.001），但与浅表 SSI 的发生率无关（RR=1.57，95%CI：0.45-5.42，p=0.48）。只有在多变量研究的亚组中，衰弱与 SSI 之间的关联仍然存在（RR=1.56，95%CI：1.34-1.80，p<0.001）。
衰弱是 TKA/THA 后 SSI 的一个潜在预测因素。
