Meta-analysis Of Risk Factors For Surgical Site Infection After Total Hip Arthroplasty In China

Objective: To systematically evaluate the related studies of total hip arthroplasty(THA)in China and analyze the risk factors of surgical site infection,so as to provide the basis for the development of control strategy of surgical site infection(SSI).Methods: 8 databases were retrieved including Embase,Pubmed,Web of Science,Cochrane,CNKI,CBM,VIP and Wanfang.Patients with SSI after total hip arthroplasty were included in the case group and SSI was not found in the control group.The outcome indexes were the relevant factors of SSI.It included 46 factors,which were classified into five categories such as social demographic factors,primary disease,merged with underlying diseases,iatrogenic factors,test indicators.Two researchers independently screened literatures,extracted data and evaluated quality according to the inclusion and exclusion criteria.After screening,all included data was analyzed by Rev Man5.2 software.Results: According to 22 studies,9073 patients underwent total hip arthroplasty,and 580 patients with surgical site infection.Meta-analysis showed that:(1)the incidences of surgical site infection after total hip arthroplasty were statistically significant in the following groups: mean age[SMD=0.85,95%CI(0.33,1.37)],60 years of age or older[OR=3.22,95%CI(2.69,5.29)],diabetes [OR=5.38,95%CI(2.78,10.39)],combined with other underlying diseases [OR=3.77,95%CI(2.69,5.29)],the average operation time[SMD= 0.73,95% CI(0.55,0.91)],operation time more than 180min[OR=2.81,95%CI(2.08,3.80)],the mean drainage time [SMD=0.67,95%CI(0.35,0.99)],drainage time more than 48h[OR=1.83,95%CI(1.31,2.56)],long-term use of hormones[OR=9.27,95%CI(4.47,19.23)],the history of hip surgery[OR=4.18,95%CI(2.29,7.63)],the mean intraoperative blood loss[SMD=0.19,95%CI(0.01,0.37)],intraoperative blood loss more than 200ml[OR= 1.99,95%CI(1.14,3.48),blood transfusion more than 800ml[OR=2.32,95%CI(1.39,3.85)],epidural anesthesia and general anesthesia[OR=1.08,95%CI(0.67,1.73)],using at least 2 kinds of antibiotics[OR=3.92,95%CI(2.19,7.02)],ASA score of III-IV level[OR=3.03,95%CI(1.51,6.08)],the hospitalization time more than 14d[OR=15.62,95%CI(5.62,43.36)],the mean preoperative albumin [SMD =-5.37,95%CI(-6.39,-4.34)],serum albumin less than 35g/L[OR=4.79,95%CI(2.26,10.16)],preoperative hemoglobin [SMD=-0.96,(-1.18,-0.75)],blood glucose [SMD=1.02,95%CI(0.60,1.45)].(2)the incidences between the following groups were no statistically significant: gender[OR=0.99,95%CI(0.82,1.20)],BMI[SMD=0.17,95%CI(-0.05,0.40)],femoral head necrosis and femoral neck fracture[OR=1.46,95%CI(0.71,2.99)],hip osteoarthritis and femoral head necrosis[OR=1.12,95%CI(0.31,4.00)],hip osteoarthritis and femoral neck fractures[OR=1.43,95%CI(0.33,6.24)],rheumatoid arthritis[OR=2.62,95%CI(0.69,9.97)],drainage time larger than 24h[OR=0.35,95%CI(10.43)],the type of prosthesis[OR=1.06,95%CI(0.69,1.62)],general anesthesia and combined anesthesia [OR=1.34,95%CI(0.79,2.26)],antibiotic using time [OR=1.17,95%CI(0.71,1.94)],surgical procedure [OR=1.68,95%CI(0.76,3.72)].Conclusion:It is recommended to set the age of more than 60 years,hospitalization time of more than 14 days,long-term using of hormone therapy,diabetes mellitus,previous history of hip surgery,serum albumin less than 35g/L,ASA scoreof III-IV level,using at least 2 kinds of antibiotics,the operation time no less than 180 min,the drainage time no less than 48 h,the amount of intraoperative bleeding more than 200 ml as the early warning signs of SSI after total hip arthroplasty.