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Postoperative Surgical Site Infections (SSIs) pose significant challenges to recovery after joint arthroplasty. This systematic review and meta-analysis aim to compare the incidence of SSIs after knee or hip arthroplasty under Spinal Anaesthesia (SA) versus general anaesthesia (GA). We conducted the systematic review and meta-analysis following the PRISMA guidelines, analysing data from 15 studies selected from PubMed, Embase, Web of Science, and Cochrane Library up to May 16, 2023. The analysis included studies comparing SSIs incidence in patients aged 18 years and above who underwent knee or hip arthroplasty under SA or GA. Quality assessment was performed using the Cochrane Collaboration's risk of bias tool. The effect size was calculated using random or fixed-effects models based on the observed heterogeneity. We assessed the heterogeneity between studies and conducted a sensitivity analysis. Of 1651 initially identified studies, 15 articles encompassing 353 169 patients were included in the final analysis. A total of 156 405 patients were under SA, while 196 764 received GA. The studies demonstrated substantial heterogeneity (p = 0.007, I 2 = 53.7%), resulting in a random-effects model being employed. Patients receiving SA showed a 23% lower likelihood of developing SSIs postoperatively compared to GA patients (OR: 0.77, 95% CI: 0.70–0.86, p < 0.001). Sub-group analysis further confirmed these findings regardless of the type of joint arthroplasty. This meta-analysis indicated a significantly lower incidence of SSIs following knee or hip arthroplasty under SA compared to GA. Despite observed heterogeneity, the results underscore the potential benefit of SA over GA in orthopaedic surgeries to reduce the risk of SSIs.
In this meta-analysis, we comprehensively evaluated the effect of endoscopic retrograde appendicitis therapy (ERAT) on surgical site infections and other perioperative outcomes in patients with acute appendicitis. Relevant studies on ERAT for acute appendicitis were retrieved from PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, and Wanfang Data, from database inception to June 2023. Statistical analyses were performed using RevMan 5.4. Heterogeneity among the included studies was analysed, and odds ratios (ORs) or standardised mean differences (SMDs), along with their respective 95% confidence intervals (CIs), were calculated. In total, 24 studies involving 1937 patients were included in the meta-analysis. ERAT reduced the surgical duration (SMD: −1.70, 95% CI: −2.24 to −1.16, p < 0.001) and length of hospital stay (SMD: −2.09, 95% CI: −2.64 to −1.53, p < 0.001) significantly more than open appendectomy (OA) did. Furthermore, ERAT decreased the incidence of surgical site wound infections (OR: 0.22, 95% CI: 0.13–0.37, p < 0.001) and postoperative complications (OR: 0.16, 95% CI: 0.11–0.21, p < 0.001) more than OA did. This study demonstrated that ERAT is a safe and effective endoscopic treatment modality for acute appendicitis, contributing to a significant reduction in the surgical duration, length of hospital stay, and incidence of surgical site wound infections and postoperative complications. Hence, ERAT has clinical significance and the potential for further application and dissemination.
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