Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection
- 作者: Bozhkova S.A.1, Liventsov V.N.1, Tikhilov R.M.1, Romano C.L.2, Kochish A.Y.1,3, Labutin D.V.1, Artyukh V.A.1
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隶属关系:
- Vreden National Medical Research Center of Traumatology and Orthopedics
- Clinica San Gaudenzio
- Kirov Military Medical Academy
- 期: 卷 28, 编号 1 (2022)
- 页面: 39-45
- 栏目: Clinical studies
- URL: https://journals.rcsi.science/2311-2905/article/view/124883
- DOI: https://doi.org/10.17816/2311-2905-1717
- ID: 124883
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Background. Protein-energy malnutrition (PEM) is an established risk factor of postoperative complications in orthopedic disorders, including arthroplasty of the large joints.
The study aimed to evaluate PEM prevalence and its association with the early postoperative revision in patients with the difficult-to-treat (DTT) prosthetic joint infection (PJI) of the hip.
Methods. The retrospective study included 132 patients with chronic DTT PJI of the hip. The patients underwent orthopedic implant removal, radical debridement of the infected tissues, and resection arthroplasty with non-free transplantation of an axial vastus lateralis muscle flap (n = 57) or installation of an antimicrobial spacer (n = 75). DTT PJI was defined as an infection caused by rifampicin-resistant staphylococcal strains, ciprofloxacin-resistant gram-negative bacteria, fungi of the genus Candida, and their associations. The assessment of the patient’s protein-energy status included the evaluation of reference laboratory parameters, such as levels of hemoglobin, total protein, and albumin and number of lymphocytes. The degree of PEM was determined by the number of laboratory markers below the threshold values. The statistical comparison was performed using Fisher’s test. The odds ratio (OR, 95% confidence interval [CI]) was calculated to assess the risk of PJI recurrence. Differences were considered significant at p<0.05.
Results. More than 70% of patients with chronic DTT PJI included in the study were diagnosed with preoperative PEM of varying degrees of severity. Hypoalbuminemia and decreased hemoglobin levels were diagnosed more often: 64.3% and 57.1% in the muscle flap plasty and 57.3% and 31.1% in the antimicrobial spacer group, respectively. In muscle plasty and antimicrobial spacer groups, a decrease in the values of three or more reference PEM markers was detected in 28.5% and 16.0% of patients, and this advanced impairment of the nutritional status increased the risk of early revision intervention by two (OR 2.0; CI 95% 0.47–8.56; p = 0.35) and six times (OR 6.11; 95% CI 1.06–35.35; p<0.04), respectively.
Conclusion. In general, the analysis of publications and results of our study show that PEM is associated with the development of surgical site infection and recurrence of PJI after revision surgery. A decrease in the values of three or more reference PEM markers is a significant predictor of repeated revisions after debridement surgery with the installation of an antimicrobial spacer. PEM complicates the postoperative course in patients with resection arthroplasty. Given the high incidence of PEM in patients with DTT PJI of the hip joint, further research is needed to develop methods for nutritional status correction and assessment of their effect on the outcomes of debridement surgery.
作者简介
Svetlana Bozhkova
Vreden National Medical Research Center of Traumatology and Orthopedics
Email: clinpharm-rniito@yandex.ru
ORCID iD: 0000-0002-2083-2424
Dr. Sci. (Med.), Head of the Research Department of Prevention and Treatment of Wound Infection and Department of Clinical Pharmacology
俄罗斯联邦, 8, Akademika Baykova str., St. Petersburg, 195427Vitaly Liventsov
Vreden National Medical Research Center of Traumatology and Orthopedics
编辑信件的主要联系方式.
Email: vnliventsov@yandex.ru
ORCID iD: 0000-0001-8748-2134
Cand. Sci. (Med.), Deputy Chief Medical Officer, orthopedic surgeon department of Purulent Surgery
俄罗斯联邦, 8, Akademika Baykova str., St. Petersburg, 195427Rashid Tikhilov
Vreden National Medical Research Center of Traumatology and Orthopedics
Email: rtikhilov@gmail.com
ORCID iD: 0000-0003-0733-2414
Dr. Sci. (Med.), Professor
俄罗斯联邦, 8, Akademika Baykova str., St. Petersburg, 195427Carlo Romano
Clinica San Gaudenzio
Email: info@carlolucaromano.com
ORCID iD: 0000-0001-6726-0593
MD, PhD, Professor, Orthopaedic Surgeon Consultant
意大利, NovaraAleksandr Kochish
Vreden National Medical Research Center of Traumatology and Orthopedics; Kirov Military Medical Academy
Email: auk1959@mail.ru
ORCID iD: 0000-0002-2466-7120
Dr. Sci. (Med.), Professor, Deputy Director for Science and education, Department of operative Surgery and Topographic anatomy
俄罗斯联邦, 8, Akademika Baykova str., St. Petersburg, 195427; St. PetersburgDmitry Labutin
Vreden National Medical Research Center of Traumatology and Orthopedics
Email: mailbox@dlabutin.com
ORCID iD: 0000-0002-4405-7688
Research Assistant, Research Department of Prevention and Treatment of Wound Infection
俄罗斯联邦, 8, Akademika Baykova str., St. Petersburg, 195427Vasily Artyukh
Vreden National Medical Research Center of Traumatology and Orthopedics
Email: artyukhva@mail.ru
ORCID iD: 0000-0002-5087-6081
Cand. Sci. (Med.), head of department of Purulent Surgery
俄罗斯联邦, 8, Akademika Baykova str., St. Petersburg, 195427参考
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