Using the Spine Surgical Invasiveness Index to Identify Risk of Surgical Site Infection A Multivariate Analysis
Using the Spine Surgical Invasiveness Index to Identify Risk of Surgical Site Infection A Multivariate Analysis
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DOI：
10.2106/jbjs.j.01084
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发表时间：
2012-02-15
影响因子：
5.3
通讯作者：
Mirza, Sohail K.
中科院分区：
文献类型：
--
作者：
Cizik, Amy M.;Lee, Michael J.;Mirza, Sohail K.
背景：脊柱手术后手术部位感染是一种众所周知的并发症，可导致不良预后、关节融合部位骨不连和神经损伤。我们假设较高的手术侵袭性评分将增加脊柱手术后手术部位感染的风险。方法：对2003年1月1日至2004年12月31日在两家学术医院接受任何类型脊柱手术的患者的数据进行分析。手术侵袭性指数是一种先前经过验证的工具，它考虑了减压、关节融合化或内固定的椎体节段以及手术入路的数量。计算了每个分类变量的相对风险和95%的可信区间。结果：对1532名接受手术部位感染评估的患者进行回归分析，发现以下是手术部位感染的显著危险因素：体重指数<35(相对危险度，2.24[95%可信区间，1.21~3.86]；p=0.01)，高血压(相对危险度，1.73[95%可信区间，1.05~2.85])；胸外科与颈椎手术(相对风险，2.57[95%可信区间，1.20至5.60]；p=0.01)，腰椎手术与颈椎手术(相对风险，2.03[95%可信区间，1.10至4.05]；p=0.02)，手术侵袭指数>；21(相对风险，3.15[95%可信区间，1.37至6.99]；结论：以手术侵袭性指数衡量，接受更具侵袭性脊柱手术的患者发生手术部位感染的风险更高，需要返回手术室进行治疗。手术侵袭性是手术部位感染的最强危险因素，即使在调整了内科合并症、年龄和其他已知危险因素后也是如此。这种相关性的大小应该在手术决策以及患者的术中和术后护理中得到考虑。这些发现进一步证实了在进行脊柱手术的安全性和临床结果比较时，侵袭性指数的重要性。
Background: Surgical site infection after spine surgery is a well-known complication that can result in poor outcomes, arthrodesis-site nonunion, and neurological injury. We hypothesized that a higher surgical invasiveness score will increase the risk for surgical site infection following spine surgery.Methods: Data were examined from patients undergoing any type of spinal surgery from January 1, 2003, to December 31, 2004, at two academic hospitals. The surgical invasiveness index is a previously validated instrument that accounts for the number of vertebral levels decompressed, arthrodesed, or instrumented as well as the surgical approach. Relative risks and 95% confidence intervals were calculated for each of the categorical variables. Multivariate binomial stepwise logistic regression was used to examine the association between surgical invasiveness and surgical site infection requiring a return to the operating room for treatment, adjusting for confounding risk factors.Results: The regression analysis of 1532 patients who were evaluated for surgical site infection identified the following significant risk factors for surgical site infection: a body mass index of >35 (relative risk, 2.24 [95% confidence interval, 1.21 to 3.86]; p = 0.01), hypertension (relative risk, 1.73 [95% confidence interval, 1.05 to 2.85]; p = 0.03), thoracic surgery versus cervical surgery (relative risk, 2.57 [95% confidence interval, 1.20 to 5.60]; p = 0.01), lumbosacral surgery versus cervical surgery (relative risk, 2.03 [95% confidence interval, 1.10 to 4.05]; p = 0.02), and a surgical invasiveness index of >21 (relative risk, 3.15 [95% confidence interval, 1.37 to 6.99]; p = 0.01).Conclusions: Patients undergoing more invasive spine surgery as measured with the surgical invasiveness index had greater risk for having a surgical site infection that required a return to the operating room for treatment. Surgical invasiveness was the strongest risk factor for surgical site infection, even after adjusting for medical comorbidities, age, and other known risk factors. The magnitude of this association should be considered during surgical decision-making and intraoperative and postoperative care of the patient. These findings further validate the importance of the invasiveness index when performing safety and clinical outcome comparisons for spine surgery.