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

A meta-analysis was conducted to determine the risk of infection following hip replacement and risk factors were identified for surgical site infection. PubMed/Medline, Embase and Cochrane Library databases were systematically searched, as well as the reference lists of previous systematic reviews and meta-analyses. The pooled odds ratio (OR) was estimated using a random effects model for each investigated factor. The evidence of observational studies was classified as high quality (class I), moderate quality (class II or III) or low quality (class IV) based on the GRADE system. A total of 25,383 potential articles met the inclusion criteria in the database search. After reviewing the titles, abstracts, and full texts, 27 articles were included in the final analysis, encompassing 699,473 patients who underwent hip arthroplasty. High-quality evidence shows that BMI (>= 30 kg/m(2)) (OR 2.16; 95% CI 1.72-2.70), male sex (OR 1.39; 95% CI 1.26-1.53), operation time (>= 120 min) (OR 1.72; 95% CI 1.39-2.14), American Society of Anesthesiologists (ASA) class >= 3 (OR 2.05; 95% CI 1.49-2.83), diabetes (OR 1.33; 95% CI 1.23-1.43), and heart disease (OR 1.99; 95% CI 1.48-2.68) are associated with a greater risk of infection. The meta-analysis revealed that age and renal disease were not associated with infection. In conclusion, this meta-analysis identified significant risk factors for infection after hip-replacement surgery, including BMI, male sex, operation time, heart disease, diabetes, and ASA class. (c) 2025 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.