Impact of wound complications in obese versus non-obese patients undergoing total hip arthroplasty: A meta-analysis

Do Meta-Analyses of Total Hip Arthroplasty Produce Reliable Results? A Systematic Review and Meta-Epidemiological Study of Statistical Methods

BACKGROUND

Total hip arthroplasty (THA) is a highly successful orthopedic procedure, with numerous meta-analyses published to optimize its outcomes. However, the reliability of their results and conclusions depends heavily on the use of appropriate statistical methods. Therefore, the aim was to test the reliability of statistical methods in meta-analyses of THA by examining the degree of heterogeneity, the effect of different between-study variance estimators, and the equality of sample size of pooled primary studies.

METHODS

The literature was systematically searched in PubMed from January 1, 2022, to December 31, 2023, for meta-analyses on THA. The quality of the meta-analyses was assessed using the revised Measurement Tool to Assess Systematic Reviews (AMSTAR 2). All meta-analyses were recalculated using eight different heterogeneity estimators. The following indicators were considered: inequality of patient numbers, proportion of random-effects and fixed-effects models, heterogeneity with I2 value, ratio of effect sizes (RES), ratio of confidence interval width (RCIW), and the number of significant results. Mixed linear regression was then used to analyze whether the effect sizes and CIW were significantly different using different heterogeneity estimators. Finally, all examined meta-analyses were recalculated using the eight heterogeneity estimators and the Hartung-Knapp (HK) adjustment.

RESULTS

Of the 24 meta-analyses examined, 15 reported an outcome using a mean difference and 20 reported an outcome using an odds ratio. The quality assessment identified 10 meta-analyses of high quality, 7 of moderate quality, 4 of low quality, and 3 of critically low quality. The significance of the examined meta-analyses varied considerably depending on the heterogeneity estimators used. In particular, the DerSimonian and Laird and Hunter-Schmidt heterogeneity estimators tended to produce false-positive results. The meta-analyses examined generally did not use HK adjustment. This effect is amplified when combined with the weak DerSimonian and Laird heterogeneity estimator, which were used in almost all examined meta-analyses.

CONCLUSION

Without HK adjustment, the results depend strongly on the heterogeneity estimator chosen and there is a risk of false positives, especially for the widely used DerSimonian and Laird heterogeneity estimator. For HK adjustment, the choice of heterogeneity estimator seems to play a less important role. We recommend the use of more reliable heterogeneity estimators as well as the HK adjustment as a measure to improve the statistical methodology of meta-analyses. This study highlights the critical need for improved statistical rigor in meta-analyses of THA, ensuring more reliable evidence for clinical decision-making and guideline development.

Perceived Risk of Elective Total Hip Arthroplasty: A Brazilian Hip Society Survey

BACKGROUND

As total hip arthroplasty (THA) has become more common and widely available, candidates now often present with multiple risk factors that increase the risk of complications, directly impacting the cost of surgery and provider compensation. The present study was designed to better understand the impact of these factors and the perceptions of hip surgeons in Brazil.

METHODS

All 880 full members of the Brazilian Hip Society (SBQ) were invited to complete an online questionnaire on preoperative risk factors, adapted from the previous American Association of Hip and Knee Surgeons survey. Statistical analyses of survey response data were performed.

RESULTS

A total of 398 responses were received (45.2% of SBQ members). Most (81.7%) work in high-complexity hospitals; 46% have more than 15 years of experience in THA; and 30.2% perform more than 100 THAs/year (47% perform 40 to 100/year). Overall, 56.5% restrict THA eligibility based on modifiable risk factors: 76.6% view malnutrition and 65.8% view poorly controlled diabetes as factors precluding THA; most (89.2%) recommend waiting six to 24 months after bariatric surgery. Although 59.5% of respondents turn down candidates who abuse alcohol, 80.9% are willing to operate on smokers and 75.6% on opioid users. Advanced age was not a relevant factor for 87.2, and 71.1% perceive risk as equal in men and women. Among respondents who restrict THA eligibility, 78% do so based on personal experience or literature, while 32.6% follow the opinion of the patient's primary clinician. 90.4% believe risk-based compensation would expand access to THA.

CONCLUSIONS

Compared to their peers in Latin America, Asia, Europe, and the United States, SBQ members have a largely similar perception of restrictions to performing THA, but are more willing to operate on smokers and more likely to defer THA in postbariatric patients. Nearly all favor adjusting surgeon compensation to take patient risk factors into account.

RETRACTION: Impact of Wound Complications in Obese Versus Non-Obese Patients Undergoing Total Hip Arthroplasty: A Meta-Analysis

RETRACTION

Y. Yang, Z. Zhao, Y. Wang, Y. Gao, H. Sun, and W. Liu, "Impact of Wound Complications in Obese Versus Non-Obese Patients Undergoing Total Hip Arthroplasty: A Meta-Analysis," International Wound Journal 20, no. 10 (2023): 4200-4207, https://doi.org/10.1111/iwj.14318. The above article, published online on 30 July 2023, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons Ltd. Following an investigation by the publisher, all parties have concluded that this article was accepted solely on the basis of a compromised peer review process. The editors have therefore decided to retract the article. The authors did not respond to our notice regarding the retraction.

Risk factors for surgical site infection after percutaneous endoscopic lumbar discectomy

The objective of this study was to investigate the risk factors associated with surgical site infection (SSI) after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). A retrospective analysis was performed on a cohort of 335 patients who underwent PELD between January 2016 and January 2023. Data were derived from the Hospital Information System (HIS), and a comprehensive statistical assessment was performed using IBM SPSS Statistics version 25.0. Both univariate and multivariate logistic regression analyses assessed a range of risk determinants, such as age, body mass index (BMI), comorbidities, laboratory test parameters and surgery-related variables. The incidence of SSI after PELD was 2.7% (9/335). Univariate analysis highlighted BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant predictors of SSI. Multivariate logistic regression identified BMI, diabetes mellitus, long-term corticosteroid consumption, surgical time and cerebrospinal fluid leakage as significant risk factors for SSI after PELD. High BMI, diabetes mellitus, long-term corticosteroid consumption, long surgical time and postoperative cerebrospinal fluid leakage are predisposing factors for SSI in patients undergoing PELD. Precise interventions focused on such risk components, including careful preoperative assessment and strategic postoperative care, are essential to reduce the incidence of SSI and improve surgical efficacy.

Impact of wound complications in obese versus non-obese patients undergoing total hip arthroplasty: A meta-analysis

This meta-analysis examined the post-operative wound effect of both obese and non-obese in total hip arthroplasty (THA) patients. To gather as complete an overview as possible, the researchers took advantage of 4 databases-PubMed, Embase, Cochrane Library and Web of Science-to conduct a critical assessment. Following the development of inclusion and exclusion criteria, the researchers evaluated the quality of each document. A total of 9 related trials were conducted to determine the 95% CI (CI) and OR using a fixed-effect model. The final meta-analyses were conducted with RevMan 5.3. Our findings indicate that there is no statistically significant benefit in terms of post-operative wound complications among obese and non-obese patients. Obese subjects had a significantly higher risk of injury than those without obesity (OR, 1.43; 95% CI, 1.04, 1.95, p = 0.03); obesity was also associated with a significantly higher risk of operative site infection than in non-obese subjects (OR, 1.96; 95% CI, 1.76, 2.18, p < 0.0001); and after surgery, there was also a significant increase in the risk of post-operative wound infections among obese subjects than in non-obese subjects (OR, 1.57; 95% CI, 1.34, 1.84, p < 0.0001). However, due to the small size of the cohort study in this meta-study, caution is required in the analysis. More randomized, controlled studies will be needed to validate these results.