Risk factors for infection in patients undergoing hip replacement: a systematic review and meta-analysis

Area of Science:

• Orthopedic Surgery
• Infectious Disease Epidemiology
• Biostatistics

Background:

• Surgical site infections (SSIs) are a significant complication following hip arthroplasty.
• Identifying modifiable and non-modifiable risk factors is crucial for infection prevention strategies.

Purpose of the Study:

• To conduct a meta-analysis to determine the risk of infection after hip replacement.
• To identify significant risk factors associated with surgical site infections in hip arthroplasty patients.

Main Methods:

• Systematic search of PubMed/Medline, Embase, and Cochrane Library databases.
• Inclusion of 27 articles comprising 699,473 patients undergoing hip arthroplasty.
• Pooled odds ratios (OR) estimated using random effects models; evidence quality assessed by GRADE system.

Main Results:

• High-quality evidence links increased infection risk to: BMI (≥30 kg/m²; OR 2.16), male sex (OR 1.39), operation time (≥120 min; OR 1.72), ASA class ≥3 (OR 2.05), diabetes (OR 1.33), and heart disease (OR 1.99).
• Age and renal disease were not found to be associated with increased infection risk.
• Significant risk factors identified include BMI, male sex, operation time, heart disease, diabetes, and ASA class.

Conclusions:

• This meta-analysis provides high-quality evidence on significant risk factors for hip replacement surgical site infections.
• Factors such as obesity, male gender, prolonged surgery, and comorbidities like diabetes and heart disease necessitate targeted preventive measures.
• Understanding these risk factors can guide clinical practice to reduce infection rates after hip arthroplasty.