关节置换术后手术部位及假体周围感染与营养不良相关性的Meta分析

Association of malnutrition with postoperative surgical site infection and periprosthetic infection in total joint arthroplasty patients: a meta-analysis

目的系统评价关节置换术后手术部位感染(SSI)和假体周围感染(PJI)与营养不良的相关性,为预防术后感染提供循证依据。方法对PubMed、Embase、中国知网(CNKI)、万方等7个中英文数据库进行无语言限制的文献检索,检索从建库至2020年6月公开发表的文献,查找关节置换术后SSI和PJI与营养不良相关性的队列研究,采用RevMan 5.4软件对符合条件的研究进行Meta分析,合并其比值比(OR)和95%置信区间(CIs),并对发表偏倚进行漏斗图分析。结果通过最初的搜索词,总共识别出文献2525篇,全文审查了248篇文章,其中有10篇文章符合入选标准。最终共纳入11项回顾性队列研究,共计262640例患者。方法学质量评价结果显示纳入研究总体质量较高(NOS≥6)。Meta分析结果显示,营养不良和非营养不良组SSI与PJI发生率差异有统计学意义,与非营养不良人群相比,营养不良人群关节置换术后SSI与PJI的发生率升高,其效应值分别为[OR=2.69,95%CI(2.58~2.82)]与[OR=3.32,95%CI(2.53~4.36)]。结论营养不良与全关节置换术后SSI和PJI有关,建议术前对营养不良的患者实施一定的优化策略。

OBJECTIVE To systematically assess the correlation between the malnutrition and the postoperative surgical site infection(SSI)and periprosthetic joint infection(PJI)in total joint arthroplasty patients so as to provide evidence-based basis for prevention of postoperative infection.METHODS A literature search was performed in 7 Chinese and English databases including Pubmed,Embase,Cochrane Library,CNKI,Wanfang,VIP and SinoMed without language restriction to collect the cohort studies regarding as the correlation between the malnutrition and the postoperative SSI and PJI in total joint arthroplasty patients,and the literatures were retrieved from the establishment of database to Jun,2020.Meta analysis was carried out for the eligible studies by using RevMan 5.4 software,their odds ratios(OR)and 95%confidence intervals(CIs)were calculated,and the funnel plot analysis was performed for publication bias.RESULTS A total of 2525 literatures were identified through the initial search of terms.Full texts were reviewed for 248 articles,10 of which met the criteria for inclusion.Totally 11 retrospective cohort studies involving 262640 cases were included.The result of methodological quality assessment indicated that the overall quality of the enrolled studies was high(NOS≥6).Meta-analysis showed that there was significant difference in the incidence of SSI and PJI between the malnutrition group and the non-malnutrition group,the incidence of postoperative SSI and PJI was higher in the total joint arthroplasty patients with malnutrition than in the patients without malnutrition,and the effect sizes were[OR=2.69,95%CI(2.58~2.82)]and[OR=3.32,95%CI(2.53~4.36)],respectively.CONCLUSION The malnutrition is associated with the postoperative SSI and PJI in the total joint arthroplasty patients.It is recommended to carry out certain optimized strategies for the patients with malnutrition before the surgery.