| Summary: | <p><strong>Background</strong>:
Classification systems for orthopaedic infection include patient health
status, but there is no consensus about which comorbidities affect prognosis. Modifiable factors including substance use, glycaemic control, malnutrition
and obesity may predict post-operative recovery from infection.
<strong>Aim</strong>:
This systematic review aimed (1) to critically appraise clinical prediction
models for individual prognosis following surgical treatment for orthopaedic
infection where an implant is not retained; (2) to understand the usefulness
of modifiable prognostic factors for predicting treatment success.
<strong>Methods</strong>:
EMBASE and MEDLINE databases were searched for clinical prediction and
prognostic studies in adults with orthopaedic infections. Infection
recurrence or re-infection after at least 6 months was the primary outcome.
The estimated odds ratios for the primary outcome in participants with
modifiable prognostic factors were extracted and the direction of the effect reported.
<strong>Results</strong>:
Thirty-five retrospective prognostic cohort studies of 92 693 patients were
included, of which two reported clinical prediction models. No studies were
at low risk of bias, and no externally validated prediction models were identified. Most focused on prosthetic joint infection. A positive
association was reported between body mass index and infection recurrence in
19 of 22 studies, similarly in 8 of 14 studies reporting smoking history and 3 of 4 studies reporting alcohol intake. Glycaemic control and
malnutrition were rarely considered.
<strong>Conclusion</strong>:
Modifiable aspects of patient health appear to predict outcomes after surgery for orthopaedic infection. There is a need to understand which factors may
have a causal effect. Development and validation of clinical prediction
models that include participant health status will facilitate treatment
decisions for orthopaedic infections.</p>
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