Introduction
Methods
Literature search
Study selection
Data extracting and quality evaluation
Statistical analyses
Results
Literature search
Study characteristics and quality
Study | Country | Design | Patient characteristics | Sample size | Mean age years | Male (%) | MetS diagnosis | MetS at baseline, n (%) | Follow-up duration | Prophylactic methods | Outcomes reported | Outcome validation | Variables adjusted |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Gandhi 2009 [16] | Canada | PC | Patients received unilateral TKA | 1460 | 66.5 | 35.9 | WHO | 135 (9.2) | 3 months | LMWH | Symptomatic DVT (65) | DUS in systematic patients | Age, sex, education, BMI, and CCI |
Dy 2011 [17] | The US | RC | Patients received TKA or THA | 16317 | 64.8 | 39.9 | NCEP-ATP III | 1093 (6.7) | 3 months | NR | VTE (148) | ICD-9 codes | Age, sex, procedure type, and BMI |
Valle 2012-TKA [18] | The US | RC | Patients received TKA | 806672 | 66.9 | 36.1 | NCEP-ATP III | 82852 (10.3) | In-hospital | NR | VTE (6476) | ICD-9 codes | Age, sex, race, admission type, comorbidities, and hospital level |
Valle 2012-THA [18] | The US | RC | Patients received THA | 406265 | 65.6 | 42.5 | NCEP-ATP III | 24269 (6.0) | In-hospital | NR | VTE (1986) | ICD-9 codes | Age, sex, race, admission type, comorbidities, and hospital level |
Mraovic 2013 [19] | The US | RC | Patients received TKA or THA | 7282 | 70.2 | 44.0 | NCEP-ATP III | 958 (13.2) | In-hospital | Warfarin to achieve INR: 1.5 ~ 2.0 | Symptomatic PE (107) | CT and/or lung VQ scan in systematic patients | Age, sex, procedure type, BMI, and comorbidities |
Song 2016-TKA [21] | China | RC | Patients received TKA | 560 | 67.2 | 18.0 | WHO | 45 (8.0) | 1 month | Rivaroxaban or LMWH | Symptomatic DVT (25) | Routine venography | Age, sex, comorbidities, and smoking |
Song 2016-THA [21] | China | RC | Patients received THA | 993 | 63.4 | 37.3 | WHO | 34 (3.4) | 1 month | Rivaroxaban or LMWH | Symptomatic DVT (53) | Routine venography | Age, sex, comorbidities, and smoking |
Edelstein 2016 [20] | The US | RC | Patients received TKA or THA | 1462 | NR | 36.5 | WHO | 237 (16.2) | 1 month | NR | PE (33) | Medical insurance data | Age, sex, BMI, and comorbidities |
Cichos 2018 [22] | The US | RC | Patients with hip fracture received THA | 100446 | 77.6 | 31.2 | NCEP-ATP III | 8437 (8.4) | In-hospital | NR | VTE (904) | ICD-9 codes | Age, sex, race, payer status and comorbidities |
Study | Representativeness of the exposed cohort | Selection of the non-exposed cohort | Ascertainment of exposure | Outcome not present at baseline | Control for age and sex | Control for other confounding factors | Assessment of outcome | Enough long follow-up duration | Adequacy of follow-up of cohorts | Total |
---|---|---|---|---|---|---|---|---|---|---|
Gandhi 2009 [16] | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 8 |
Dy 2011 [17] | 0 | 1 | 1 | 0 | 1 | 0 | 1 | 1 | 1 | 6 |
Valle 2012-TKA [18] | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 6 |
Valle 2012-THA [18] | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 6 |
Mraovic 2013 [19] | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 6 |
Song 2016-TKA [21] | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 8 |
Song 2016-THA [21] | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 8 |
Edelstein 2016 [20] | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 7 |
Cichos 2018 [22] | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 6 |
Association between MetS and VTE after TJA
Studies omitted | RR | 95% CI | I2 | P for effect |
---|---|---|---|---|
Gandhi 2009 [16] | 1.17 | 0.84 to 1.62 | 69% | 0.35 |
Dy 2011 [17] | 1.22 | 0.86 to 1.72 | 72% | 0.26 |
Valle 2012-TKA [18] | 1.40 | 0.89 to 2.22 | 68% | 0.15 |
Valle 2012-THA [18] | 1.38 | 0.87 to 2.17 | 73% | 0.17 |
Mraovic 2013 [19] | 1.18 | 0.82 to 1.68 | 67% | 0.37 |
Song 2016-TKA [21] | 1.10 | 0.82 to 1.48 | 61% | 0.53 |
Song 2016-THA [21] | 1.14 | 0.83 to 1.58 | 67% | 0.41 |
Edelstein 2016 [20] | 1.31 | 0.93 to 1.84 | 72% | 0.13 |
Cichos 2018 [22] | 1.37 | 0.95 to 1.98 | 70% | 0.10 |