RISK-FACTORS FOR WOUND INFECTIONS AFTER TOTAL KNEE ARTHROPLASTY
RISK-FACTORS FOR WOUND INFECTIONS AFTER TOTAL KNEE ARTHROPLASTY
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DOI：
10.1093/oxfordjournals.aje.a115580
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发表时间：
1990-05-01
影响因子：
5
通讯作者：
JARVIS, WR
中科院分区：
文献类型：
--
作者：
GORDON, SM;CULVER, DH;JARVIS, WR
伤口感染是全膝关节置换术的一种罕见但严重的并发症。1984年1月至1987年11月，在两所附属医院的243例患者中，有20例（8.2%）在清洁空气手术室进行了259例全膝关节置换术后发生了手术伤口感染。18例（90%）患者发生深部感染; 9例需要取出假体。一名外科医生（外科医生X）与18例发生后续感染的手术相关（风险比（RR）= 9.4，95%置信区间（CI）2.2-39），并进行了一项调查，以解释外科医生X与其他外科医生之间感染率的差异。在一项队列研究中，分层分析确定了术前美国麻醉医师协会（阿萨）身体状态等级≥。3、外科医生S和术后早期使用持续被动运动器械是全膝关节置换术后手术伤口感染的相关风险因素。逻辑回归分析确定患者由外科医生X进行手术，阿萨分级≥。3是全膝关节置换术相关手术伤口感染的唯一显著独立风险因素（RR = 9.3，95% CI 2.8-31）。外科医生X的影响不能通过接受或及时给予抗菌预防、插入的假体类型、手术持续时间、术后使用持续被动活动或关节疾病的潜在病因来解释。作者得出结论，手术技术和患者疾病严重程度是全膝关节置换术后手术伤口感染的主要决定因素。这项研究证明了外科伤口感染流行病学调查的复杂性，以及在解释外科医生特异性感染率时考虑患者疾病严重程度的重要性。
Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and Novemer 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms. Eighteen (90%) of the patients had deep infections; nine required removal of the prosthesis. A single surgeon (surgeon X) was associated with 18 of the procedures that had subsequent infection (risk ratio (RR) = 9.4, 95% confidence interval (CI) 2.2-39), and an investigation was carried out in an effort to explain the difference in infection rates between surgeon X and other surgeons. In a cohort study, stratified analyses identified a preoperative American Society of Anesthesiologists (ASA) physical status class .gtoreq. 3, surgeon S, and early postoperative use of a continuous passive motion device as risk factors associated with surgical wound infection following total knee arthroplasty procedures. Logistic regression analyses identified being a patient operated on by surgeon X with an ASA class .gtoreq. 3 as the only significant independent risk factor for total knee arthroplasty-associated surgical wound infections (RR = 9.3, 95% CI 2.8-31). The effect due to surgeon X could not be explained by receipt or timeliness of administration of antimicrobial prophylaxis, type of prosthesis inserted, duration of operation, postoperative use of continuous passive motion, or underlying etiology of joint disease. The authors conclude that surgical technique and patient''s severity of illness were the primary determinants of surgical wound infection after total knee arthroplasy. This study demonstrates the complexity of epidemiologic investigation of surgical wound infections and the importance of considering patient severity of illness when interpreting surgeon-specific infection rates.