Risk factors for surgical site infection following orthopaedic spinal operations
Risk factors for surgical site infection following orthopaedic spinal operations
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DOI：
10.2106/jbjs.f.01515
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发表时间：
2008-01-01
影响因子：
5.3
通讯作者：
Fraser, Victoria J.
中科院分区：
文献类型：
--
作者：
Olsen, Margaret A.;Nepple, Jeffrey J.;Fraser, Victoria J.
背景：脊柱手术后手术部位感染并不少见，它们可能与严重的发病率、死亡率和资源利用率的增加有关。准确识别风险因素对于制定预防这些潜在破坏性感染的战略至关重要。我们进行了一项病例对照研究，以确定骨科脊柱手术后手术部位感染的独立危险因素。方法：我们对1998-2002年间在一所大学附属三级保健医院进行骨科脊柱手术的患者进行了一项回顾性病例对照研究。确定了46例浅表、深层或器官间隙手术部位感染的患者，并与227名未感染的对照组患者进行了比较。用单因素分析和多因素Logistic回归分析确定手术部位感染的危险因素。结果：在研究的五年中，脊柱手术部位感染的总发生率为2.0%(2316例中的46例)。单变量分析显示，发生手术部位感染的患者在手术前和术后5天内的血糖水平显著高于未感染的对照组患者。多因素分析确定的手术部位感染的独立危险因素是糖尿病(优势比=3.5，95%可信区间=1.2，10.0)，预防性抗生素治疗的次佳时机(优势比=3.4，95%可信区间=1.5，7.9)，术前血糖水平为125 mg/dL(>；6.9 mmol/L)或术后血糖水平为200 mg/dL(>；11.1 mmol/L)(优势比=3.3，95%可信区间=1.4、7.5)、肥胖(优势比=2.2，95%可信区间=1.1、4.7)、有两名或以上外科住院医师参与手术(优势比=2.2，95%可信区间=1.0、4.7)。手术累及颈椎可降低手术部位感染的风险(优势比=0.3，95%可信区间=0.1，0.6)。结论：糖尿病与脊柱手术部位感染的独立风险最高相关，手术前或术后血糖水平升高也与手术部位感染风险增加独立相关。对于先前未诊断为糖尿病的患者，高血糖作为手术部位感染的危险因素的作用应进一步调查。在手术前一小时内使用预防性抗生素和增加抗生素剂量以适应肥胖也是降低脊柱手术后手术部位感染风险的重要策略。\证据级别：预后级别III。有关证据级别的完整说明，请参阅作者说明。
Background: Surgical site infections are not uncommon following spinal operations, and they can be associated with serious morbidity, mortality, and increased resource utilization. The accurate identification of risk factors is essential to develop strategies to prevent these potentially devastating infections. We conducted a case-control study to determine independent risk factors for surgical site infection following orthopaedic spinal operations.Methods: We performed a retrospective case-control study of patients who had had an orthopaedic spinal operation performed at a university-affiliated tertiary-care hospital from 1998 to 2002. Forty-six patients with a superficial, deep, or organ-space surgical site infection were identified and compared with 227 uninfected control patients. Risk factors for surgical site infection were determined with univariate analyses and multivariate logistic regression.Results: The overall rate of spinal surgical site infection during the five years of the study was 2.0% (forty-six of 2316). Univariate analyses showed serum glucose levels, preoperatively and within five days after the operation, to be significantly higher in patients in whom surgical site infection developed than in uninfected control patients. Independent risk factors for surgical site infection that were identified by multivariate analysis were diabetes (odds ratio = 3.5, 95% confidence interval = 1.2, 10.0), suboptimal timing of prophylactic antibiotic therapy (odds ratio = 3.4, 95% confidence interval = 1.5, 7.9), a preoperative serum glucose level of > 125 mg/dL (> 6.9 mmol/L) or a postoperative serum glucose level of > 200 mg/dL (> 11.1 mmol/L) (odds ratio = 3.3, 95% confidence interval = 1.4, 7.5), obesity (odds ratio = 2.2, 95% confidence interval = 1.1, 4.7), and two or more surgical residents participating in the operative procedure (odds ratio = 2.2, 95% confidence interval = 1.0, 4.7). A decreased risk of surgical site infection was associated with operations involving the cervical spine (odds ratio = 0.3, 95% confidence interval = 0.1, 0.6).Conclusions: Diabetes was associated with the highest independent risk of spinal surgical site infection, and an elevated preoperative or postoperative serum glucose level was also independently associated with an increased risk of surgical site infection. The role of hyperglycemia as a risk factor for surgical site infection in patients not previously diagnosed with diabetes should be investigated further. Administration of prophylactic antibiotics within one hour before the operation and increasing the antibiotic dosage to adjust for obesity are also important strategies to decrease the risk of surgical site infection after spinal operations.\Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.