胸腰椎后路内固定术后早期切口感染的影响因素
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摘要
目的探讨胸腰椎后路内固定术后患者发生早期切口感染的危险因素。方法回顾分析我院2013年至2016年行胸腰椎后路椎弓根钉内固定治疗的1 142例患者。术后发生早期手术部位感染的50例为感染组,按1∶2比例随机抽取102例未感染患者进行病例-对照研究,以可能影响术后感染的自身因素(年龄、体质量指数、既往脊柱手术病史、糖尿病、吸烟史,血浆白蛋白)及手术相关因素(手术时间,术中出血量,输血)为自变量,应用logistic逐步回归方法筛选各危险因素是否与术后感染之间存在相关,找出影响术后感染发生的危险因素。结果患者早期手术部位感染发生率为4.38%。多因素回归分析显示,糖尿病(P=0.041)、血浆白蛋白水平(P=0.001)、吸烟史(P=0.03)、术中出血量(P=0.008)及手术时间(P=0.022)对患者胸腰椎后路术后早期切口感染有明显影响。结论糖尿病、吸烟史、血浆白蛋白水平、术中出血量及手术时间为胸腰椎后路早期手术切口感染的危险因素。
Objective To investigate the risk factors associated with acute surgical site infection(SSI) after thoracolumbar posterior internal fixation. Methods A retrospective study was performed to investigate 50 cases of acute SSI in 1 142 patients admitted to our hospital between 2013 and 2016. Various patient-related factors(age,body mass index,history of spinal surgery,diabetes,smoking habits,and plasma albumin levels) and intraoperative factors(operative time,estimated blood loss,and blood transfusion) were analyzed using multivariate regression analysis to evaluate their association with acute SSI. Results The acute SSI rate was 4.38%. Binary multivariate logistic regression analysis showed that diabetes(P = 0.041),plasma albumin levels(P = 0.001),smoking habits(P = 0.03),estimated blood loss(P = 0.008),and operative time(P = 0.022) were significantly associated with acute SSI. Conclusion Diabetes,smoking habits,plasma albumin levels,estimated blood loss,and prolonged operative time are significantly associated with increased rates of acute SSI.
Objective To investigate the risk factors associated with acute surgical site infection(SSI) after thoracolumbar posterior internal fixation. Methods A retrospective study was performed to investigate 50 cases of acute SSI in 1 142 patients admitted to our hospital between 2013 and 2016. Various patient-related factors(age,body mass index,history of spinal surgery,diabetes,smoking habits,and plasma albumin levels) and intraoperative factors(operative time,estimated blood loss,and blood transfusion) were analyzed using multivariate regression analysis to evaluate their association with acute SSI. Results The acute SSI rate was 4.38%. Binary multivariate logistic regression analysis showed that diabetes(P = 0.041),plasma albumin levels(P = 0.001),smoking habits(P = 0.03),estimated blood loss(P = 0.008),and operative time(P = 0.022) were significantly associated with acute SSI. Conclusion Diabetes,smoking habits,plasma albumin levels,estimated blood loss,and prolonged operative time are significantly associated with increased rates of acute SSI.
引文
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[8]KIM BD,HSU WK,DE OLIVEIRA GS,et al.Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion:an analysis of 4588 surgical cases[J].Spine(Phila Pa 1976),2014,39(6):510-520.DOI:10.1097/BRS.0000000000000163.
[9]ROY-CAMILLE R,SAILLANT G,MAZEL C.Internal fixation of the lumbar spine with pedicle screw plating[J].Clin Orthop Relat Res,1986,203:7-17.
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[11]FANG A,HU SS,ENDRES N,et al.Risk factors for infection after spinal surgery[J].Spine(Phila Pa 1976),2005,30(12):1460-1465.
[12]DEMURA S,KAWAHARA N,MURAKAMI H,et al.Surgical site infection in spinal metastasis:risk factors and countermeasures[J].Spine(Phila Pa 1976),2009,34(6):635-639.DOI:10.1097/BRS.0b013e31819712ca.
[13]WIMMER C,GLUCH H,FRANZREB M,et al.Predisposing factors for infection in spine surgery:a survey of 850 spinal procedures[J].J Spinal Disord,1998,11(2):124-128.
[14]S RENSEN LT,NIELSEN HB,KHARAZMI A,et al.Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes[J].Surgery,2004,136(5):1047-1053.
[15]KOTANI N,KUSHIKATA T,HASHIMOTO H,et al.Recovery of intraoperative microbicidal and inflammatory functions of alveolar immune cells after a tobacco smoke-free period[J].Anesthesiology,2001,94(6):999-1006.
[16]CHACKO AG,MOORTHY RK,CHANDY MJ.The transpedic-ular approach in the anagement of thoracic spine tu-berculosis:a shortterm follow up study[J].Spine,2004,29(17):E363-367.
[17]MOK JM,GUILLAUME TJ,TALU U,et al.Clinical out come of deep wound infection af t er inst rumented posterior spinal fusion:a mat ched cohort analysis[J].Spine(Phila Pa 1976),2009,34(6):578-583.DOI:10.1097/BRS.0b013e31819a827c.
[18]KANAYAMA M,HASHIMOTO T SHIGENOBU K,et al.Effective prevention of surgical site infection using a centers for disease control and prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery[J].J Neurosurg Spine,2007,6(4):327-329.
[2]TAKAHASHI H,WADA A,IIDA Y,et al.Antimicrobial prophylaxis for spinal surgery[J].J Orthop Sci,2009,14(1):40-44.DOI:10.1007/s00776-008-1296-5.
[3]UMEMURA T,KAWAMURA T,HOTTA N.Pathogenesis and neuroimaging of cerebral large and small vessel disease in type 2 diabetes:a possible link between cerebral and retinal microvascular abnormalities[J].J Diabetes Investig,2017,8(2):134-148.DOI:10.1111/jdi.12545.
[4]GOLINVAUX NS,VARTHI AG,BOHL DD,et al.Complication rates following elective lumbar fusion in patients with diabetes:insulin dependence makes the difference[J].Spine(Phila Pa 1976),2014,39(21):1809-1816.DOI:10.1097/BRS.0000000000000506.
[5]KOUTSOUMBELIS S,HUGHES AP,GIRARDI FP,et al.Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis[J].J Bone Joint Surg Am,2011,93(17):1627-1633.DOI:10.2106/JBJS.J.00039.
[6]FEI Q,LI J,LIN J,et al.Risk factors for surgical site infection after spinal surgery:a meta-analysis[J].World Neurosurg,2016,11(95):507-515.DOI:10.1016/j.wneu.2015.05.059.
[7]PARCHI PD,EVANGELISTI G,ANDREANI L,et al.Postoperative spine infections[J].Orthop Rev(Pavia),2015,7(3):5900.DOI:10.4081/or.2015.5900.
[8]KIM BD,HSU WK,DE OLIVEIRA GS,et al.Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion:an analysis of 4588 surgical cases[J].Spine(Phila Pa 1976),2014,39(6):510-520.DOI:10.1097/BRS.0000000000000163.
[9]ROY-CAMILLE R,SAILLANT G,MAZEL C.Internal fixation of the lumbar spine with pedicle screw plating[J].Clin Orthop Relat Res,1986,203:7-17.
[10]PERRY JW,MONTGOMERIE JZ,SWANK S,et al.Wound infections following spinal fusion with posterior segmental spinal instrumentation[J].Clin Infect Dis,1997,24(4):558-561.
[11]FANG A,HU SS,ENDRES N,et al.Risk factors for infection after spinal surgery[J].Spine(Phila Pa 1976),2005,30(12):1460-1465.
[12]DEMURA S,KAWAHARA N,MURAKAMI H,et al.Surgical site infection in spinal metastasis:risk factors and countermeasures[J].Spine(Phila Pa 1976),2009,34(6):635-639.DOI:10.1097/BRS.0b013e31819712ca.
[13]WIMMER C,GLUCH H,FRANZREB M,et al.Predisposing factors for infection in spine surgery:a survey of 850 spinal procedures[J].J Spinal Disord,1998,11(2):124-128.
[14]S RENSEN LT,NIELSEN HB,KHARAZMI A,et al.Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes[J].Surgery,2004,136(5):1047-1053.
[15]KOTANI N,KUSHIKATA T,HASHIMOTO H,et al.Recovery of intraoperative microbicidal and inflammatory functions of alveolar immune cells after a tobacco smoke-free period[J].Anesthesiology,2001,94(6):999-1006.
[16]CHACKO AG,MOORTHY RK,CHANDY MJ.The transpedic-ular approach in the anagement of thoracic spine tu-berculosis:a shortterm follow up study[J].Spine,2004,29(17):E363-367.
[17]MOK JM,GUILLAUME TJ,TALU U,et al.Clinical out come of deep wound infection af t er inst rumented posterior spinal fusion:a mat ched cohort analysis[J].Spine(Phila Pa 1976),2009,34(6):578-583.DOI:10.1097/BRS.0b013e31819a827c.
[18]KANAYAMA M,HASHIMOTO T SHIGENOBU K,et al.Effective prevention of surgical site infection using a centers for disease control and prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery[J].J Neurosurg Spine,2007,6(4):327-329.