High-dose dual antibiotic cement for hip hemiarthroplasty : a post-hoc Bayesian analysis of a randomized controlled trial.

IF 4.6 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2025-09-01 DOI:10.1302/0301-620X.107B9.BJJ-2024-1364.R1

Luke Farrow, Jemma Hudson, Alan George, Mike R Reed, Marion K Campbell

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引用次数: 0

Abstract

Aims: In this study we aimed to evaluate how a post-hoc Bayesian analysis of results from the large multicentre World Hip Trauma Evaluation (WHiTE) 8 (High-dose dual-antibiotic-loaded cement for hip hemiarthroplasty) trial might aid clinical interpretation.

Methods: Using anonymized data, a post-hoc Bayesian Poisson regression adjusting for age, sex, and centre (random effects), with 200,000 iterations, was undertaken to compare high-dose dual-antibiotic cement versus single-antibiotic cement for the primary outcome reduction of deep surgical site infection (dSSI) at 90 days. Two set of priors were used: reference priors and a data-derived prior. We assessed the posterior probabilities (PP) of relative risk (RR) (for any benefit (RR > 1), modest benefit (> 1.25), and large benefit (> 1/5)) and risk difference (RD).

Results: There were 38/2,187 (1.7%) and 27/2,219 (1.2%) dSSIs identified at 90 days in the single-antibiotic and high-dose dual-antibiotic cement groups, respectively (original analysis (OR) 1.44 (95% CI 0.88 to 2.37)). With a minimally informative reference prior there was a posterior median (PM) RR for dSSI of 1.42 (95% credible interval (CrI) 0.87 to 2.36), with a 92% PP of a RR > 1 and an 81% PP of a RD > 0.25 in favour of high-dose dual-antibiotic cement. When utilizing the data-driven prior without downweighting, there was a PM RR for dSSI of 1.62 (95% CrI 1.03 to 2.59), with a 98% PP of a RR > 1 and a 93% PP of a RD > 0.25.

Conclusion: This Bayesian re-analysis demonstrates that it is highly probable (> 90%) that there is at least some reduction of dSSI related to high-dose dual-antibiotic cement use when performing hemiarthroplasty; adding useful clinical nuance to the original trial findings in context of the noteworthy detrimental impact of dSSI in the study population. This study also highlights the potential benefits of a Bayesian approach to analysis due to improved interpretability of trial outcomes.

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大剂量双抗生素骨水泥用于髋关节置换术：随机对照试验的事后贝叶斯分析。

目的：在本研究中，我们旨在评估大型多中心世界髋关节创伤评估（WHiTE） 8（高剂量双抗生素骨水泥用于髋关节置换术）试验结果的事后贝叶斯分析如何有助于临床解释。方法：使用匿名数据，对年龄、性别和中心（随机效应）进行20万次的事后贝叶斯泊松回归，比较高剂量双抗生素水泥与单抗生素水泥在90天内减少深部手术部位感染（dSSI）的主要结局。使用了两组先验：参考先验和数据派生先验。我们评估了相对风险（RR）的后验概率（PP）（任何获益（RR为1:1），中等获益（>为1.25）和大获益（>为1/5））和风险差异（RD）。结果：在单抗生素和高剂量双抗生素骨水泥组中，90天分别有38/ 2187（1.7%）和27/ 2219（1.2%）例dsi（原始分析（OR） 1.44 (95% CI 0.88至2.37)）。根据最小信息参考，dSSI的后中位数（PM） RR为1.42(95%可信区间（CrI） 0.87至2.36)，支持高剂量双抗生素水泥的RR >为92%，RD >为81%。当利用数据驱动的先验而不降低权重时，dSSI的PM RR为1.62 (95% CrI 1.03至2.59),RR >的PP为98%，RD >的PP为93%。结论：本贝叶斯再分析表明，在进行半关节置换术时，使用高剂量双抗生素骨水泥至少有一定程度的dSSI降低是极有可能的（> - 90%）；在研究人群中dSSI显著有害影响的背景下，为原始试验结果增加了有用的临床细微差别。本研究还强调了贝叶斯分析方法的潜在好处，因为它提高了试验结果的可解释性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

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