Inoue Daisuke, Kabata Tamon, Kajino Yoshitomo, Yanagi Yu, Ima Musashi, Demura Satoru
Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Arch Orthop Trauma Surg. 2024 Dec 21;145(1):75. doi: 10.1007/s00402-024-05686-8.
Previous study did not clarify the correlation between the natural course of perioperative blood tests and occurrence of wound-related complications, including SSI, PJI, and delayed wound healing. This study aimed to investigate whether perioperative laboratory test is effective in identifying wound-related complications after THA.
This retrospective, single-institutional study enrolled 1072 patients who underwent primary THAs. We identified all cases of perioperative wound-related complications, including surgical site infection (SSI), periprosthetic joint infection (PJI), and delayed wound healing. First, we investigated which factors influenced perioperative wound complications using multivariate analysis. Second, we did 2:1 case-control study between no complications and complication group by matching on age, BMI, diagnosis, ASA class, Charlson comorbidity index. The results of perioperative laboratory tests were compared between two groups. Third, we investigated whether there was an effective threshold for perioperative wound complications on serum CRP and D-dimer.
Twenty-six cases of THA, comprising SSI in 9 hips (0.8%), PJI in 10 hips (0.9%), and 7 hips with wound delay healing (0.7%), demonstrated perioperative wound-related complications. Multivariate analysis showed that ASA class, Charlson comorbidity index, and serum CRP values in 1 week postoperatively influenced perioperative wound complications, meanwhile serum D-dimer did not show the statistical difference. After case-control matching on patient factors, the result of any blood samples did not show statistical difference in complication group. Also, no significant threshold for detecting wound-related complications was found in serum CRP and D-dimer.
The main role of perioperative blood tests is to recognize preoperative patient factors in order to early detect of perioperative wound complications. Serum CRP values in 1 week postoperatively may play a supplemental role in taking care of perioperative wound complication.
先前的研究并未阐明围手术期血液检查的自然过程与伤口相关并发症（包括手术部位感染、假体周围关节感染和伤口延迟愈合）的发生之间的相关性。本研究旨在调查围手术期实验室检查在识别全髋关节置换术后伤口相关并发症方面是否有效。
这项回顾性单机构研究纳入了1072例行初次全髋关节置换术的患者。我们确定了所有围手术期伤口相关并发症的病例，包括手术部位感染（SSI）、假体周围关节感染（PJI）和伤口延迟愈合。首先，我们使用多变量分析研究了哪些因素会影响围手术期伤口并发症。其次，我们通过对年龄、体重指数、诊断、美国麻醉医师协会（ASA）分级、查尔森合并症指数进行匹配，在无并发症组和并发症组之间进行了2:1病例对照研究。比较了两组围手术期实验室检查的结果。第三，我们研究了血清C反应蛋白（CRP）和D-二聚体在围手术期伤口并发症方面是否存在有效阈值。
26例全髋关节置换术患者出现了围手术期伤口相关并发症，其中9髋发生手术部位感染（0.8%），10髋发生假体周围关节感染（0.9%），7髋出现伤口延迟愈合（0.7%）。多变量分析表明，ASA分级、查尔森合并症指数以及术后1周的血清CRP值会影响围手术期伤口并发症，而血清D-二聚体未显示出统计学差异。在根据患者因素进行病例对照匹配后，并发症组中任何血液样本的结果均未显示出统计学差异。此外，在血清CRP和D-二聚体中未发现检测伤口相关并发症的显著阈值。
围手术期血液检查的主要作用是识别术前患者因素，以便早期发现围手术期伤口并发症。术后1周的血清CRP值在处理围手术期伤口并发症方面可能起到辅助作用。
