Factors affecting the incidence of infection in hip and knee replacement AN ANALYSIS OF 5277 CASES
Factors affecting the incidence of infection in hip and knee replacement AN ANALYSIS OF 5277 CASES
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DOI：
10.1302/0301-620x.92b8.24333
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发表时间：
2010-08-01
影响因子：
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通讯作者：
Martin, D. K.
中科院分区：
文献类型：
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作者：
Willis-Owen, C. A.;Konyves, A.;Martin, D. K.
关节置换术后感染仍然是一个重要而常见的并发症，关于哪些因素是重要的存在争议。很少有研究调查手术时间对感染的影响。我们前瞻性地收集了5277例髋关节和膝关节置换术的数据，包括手术类型、手术时间、引流管的使用、手术室、外科医生、年龄和性别。在3449例膝关节置换术亚组中，使用止血带时间代替手术时间进行进一步分析。根据澳大利亚手术部位感染标准定义的浅表、深部或关节间隙术后感染，使用广义线性模型对这些变量进行评估。总感染率为0.98%。在替换数据集中，男性性别（z = 3.097, p = 0.00195）和手术时间延长（z = 4.325, p < 0.001）是感染的预测因素。在膝关节亚组中，男性（z = 2.250, p = 0.02447），较长的止血带时间（z = 2.867, p = 0.00414）和全膝关节置换术（z = -2.052, p = 0.0420）是感染的预测因素。这些发现支持了延长手术时间和男性与感染发生率增加有关的观点。应采取措施尽量减少术中延误，并在采取延长关节置换术持续时间的措施时应谨慎行事。
Infection remains a significant and common complication after joint replacement and there is debate about which contributing factors are important. Few studies have investigated the effect of the operating time on infection.We collected data prospectively from 5277 hip and knee replacements which included the type of procedure, the operating time, the use of drains, the operating theatre, surgeon, age and gender. In a subgroup of 3449 knee replacements further analysis was carried out using the tourniquet time in place of the operating time. These variables were assessed by the use of generalised linear modelling against superficial, deep or joint-space post-operative infection as defined by the Australian Surgical-Site Infection criteria.The overall infection rate was 0.98%. In the replacement data set both male gender (z = 3.097, p = 0.00195) and prolonged operating time (z = 4.325, p < 0.001) were predictive of infection. In the knee subgroup male gender (z = 2.250, p = 0.02447), a longer tourniquet time (z = 2.867, p = 0.00414) and total knee replacement (versus unicompartmental knee replacement) (z = -2.052, p = 0.0420) were predictive of infection.These findings support the view that a prolonged operating time and male gender are associated with an increased incidence of infection. Steps to minimise intra-operative delay should be instigated, and care should be exercised when introducing measures which prolong the duration of joint replacement.