术前牙科评估减少全关节置换术患者假体周围关节感染:系统回顾和荟萃分析。

IF 1.6 Q2 ANESTHESIOLOGY
Zbigniew Putowski, Magdalena Miłobędzka, Michał Kisiołek, Wojciech Szczeklik, Roman Jaeschke, Piotr Puc, Katarzyna Szczeklik
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引用次数: 0

摘要

至少在一些骨科中心,术前牙科评估(PDA)以防止全关节置换术(TJA)后假体周围关节感染(PJI)的要求似乎是一种常见的做法。很少有研究检验过这种干预。常规转介患者进行常规PDA会增加成本,并可能延长手术时间。为了研究PDA对TJA后PJI发生频率的影响,我们对包括成年TJA患者在内的观察性研究进行了系统回顾和荟萃分析。通过MEDLINE、EMBASE、Web of Science和谷歌Scholar数据库搜索符合条件的研究。干预组为行过PDA的患者,对照组为未行过PDA的患者。主要结果是PJI的存在。除传统的meta分析外,还进行了贝叶斯分析和试验序列分析。该分析包括五项观察性研究。考虑到PJI作为结果,偏倚的总风险被评估为严重。这些研究共纳入23175例患者,其中12324例患有PDA。PDA与不PDA对PJI发生率无影响(OR 0.86, 95% CI: 0.50-1.49;I²= 42%)。贝叶斯分析显示,PDA降低PJI频率的后验概率为69.1%。因此,在TJA患者中,PDA是否影响术后PJI的发生尚不清楚。没有足够的证据支持常规实施这种干预。卫生保健系统和个别组织可能需要根据这一有限的信息作出是否继续实施这类计划的决定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Preoperative dental assessment for the reduction of periprosthetic joint infections in patients undergoing total joint replacement: a systematic review and meta-analysis.

The requirement for preoperative dental assessment (PDA) to prevent periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) seems to be a common practice at least in some orthopaedic centres. There are few studies which have examined this intervention. Routine referral of patients for routine PDA increases costs and potentially prolongs the time to the procedure. In order to investigate the effect of PDA on the frequency of PJI after TJA, we conducted a systematic review with meta-analysis of observational studies including adult patients undergoing TJA. The search for eligible studies was performed across MEDLINE, EMBASE, Web of Science, and Google Scholar databases. The intervention group consisted of patients who had undergone PDA, while the control group consisted of patients without PDA. The main outcome was the presence of PJI. In addition to traditional meta-analysis, a Bayesian analysis and trial sequential analysis were performed. The analysis included five observational studies. Considering PJI as an outcome, the total risk of bias was assessed as serious. A total of 23 175 patients were included in those studies, of whom 12 324 had a PDA. There was no effect of PDA versus no PDA on the incidence of PJI (OR 0.86, 95% CI: 0.50-1.49; I² = 42%). Bayesian analysis showed that the posterior probability of PDA reducing the frequency of PJI was 69.1%. Thus it was concluded that, in patients undergoing TJA, it remains unknown whether PDA influences the occurrence of postoperative PJI. There is insufficient evidence to support performing this intervention routinely. The health care systems and individual organisations will likely need to make decisions on continuation of such programmes on the basis of this limited amount of information.

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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
48
审稿时长
25 weeks
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