Risk Factors for Postoperative Infection Following Posterior Lumbar Instrumented Arthrodesis
Risk Factors for Postoperative Infection Following Posterior Lumbar Instrumented Arthrodesis
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DOI：
10.2106/jbjs.j.00039
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发表时间：
2011-09-07
影响因子：
5.3
通讯作者：
Sama, Andrew A.
中科院分区：
文献类型：
--
作者：
Koutsoumbelis, Stelios;Hughes, Alexander P.;Sama, Andrew A.
背景：脊柱手术部位感染是一种严重的术后并发症。在文献中，后路手术入路、关节固定术、脊柱内固定器械的使用、年龄、肥胖、糖尿病、吸烟、手术室环境和估计失血量等因素都已被确定影响感染风险。本研究的目的是分析和确定手术部位感染的独立危险因素，脊柱患者进行后路腰椎内固定arthrodesis.Methods：3218例患者进行后路腰椎内固定arthrodesis 2000年1月至2006年12月的病历进行了审查，以确定那些谁开发了术后感染（84例; 2.6%）。这个单一机构患者组的规模允许构建多变量逻辑回归模型来评估脊柱手术部位感染的潜在风险因素的独立关联。在最终的回归模型中，肥胖、估计术中失血量、手术室中十人或十人以上、硬脑膜撕裂、糖尿病史、慢性阻塞性肺病、冠心病、和骨质疏松症是脊柱手术部位感染发生的关键危险因素。在调整所有其他变量后，肥胖和慢性阻塞性肺疾病史是术后脊柱感染的最强危险因素。最常见的病原体是耐甲氧西林金黄色葡萄球菌，患病率为34.5%。本研究确定了后路腰椎内固定术的单一机构感染率为2.6%。结论：本分析证实了先前证实的术后感染的危险因素，同时报告了新的潜在独立危险因素，即骨质疏松症、慢性阻塞性肺病和硬膜撕裂。新的研究领域可以集中在这些新的因素可能在脊柱手术部位感染的发病机制中发挥的作用。证据等级：预后II级。证据等级的完整描述见作者说明。
Background: Surgical site infection in the spine is a serious postoperative complication. Factors such as posterior surgical approach, arthrodesis, use of spinal instrumentation, age, obesity, diabetes, tobacco use, operating-room environment, and estimated blood loss are well established in the literature to affect the risk of infection. The goal of this study was to analyze and identify independent risk factors for surgical site infection among spine patients undergoing posterior lumbar instrumented arthrodesis.Methods: The medical records of 3218 patients who underwent posterior lumbar instrumented arthrodesis from January 2000 to December 2006 were reviewed to identify those who developed a postoperative infection (eighty-four patients; 2.6%). The size of this single-institution patient group allowed construction of a multivariate logistic regression model to evaluate the independent associations of potential risk factors for surgical site infection in the spine.Results: In the final regression model, obesity, estimated intraoperative blood loss, ten or more people in the operating room, a dural tear, history of diabetes, chronic obstructive pulmonary disease, coronary heart disease, and osteoporosis were critical risk factors for the onset of spinal surgical site infection. Obesity and a history of chronic obstructive pulmonary disease were the strongest risk factors for postoperative spinal infection after adjusting for all other variables. The most common pathogen was methicillin-resistant Staphylococcus aureus with a prevalence of 34.5%. This study established a single institution infection rate for posterior lumbar instrumented arthrodesis at 2.6%.Conclusions: This analysis confirms previously demonstrated risk factors for postoperative infection while reporting on new potential independent risk factors of osteoporosis, chronic obstructive pulmonary disease, and dural tears in the setting of posterior lumbar instrumented arthrodesis. Areas of new research can focus on the roles these novel factors may play in the pathogenesis of surgical site infections in the spine.Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.