Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases Clinical article
Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases Clinical article
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DOI：
10.3171/2013.10.spine1364
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发表时间：
2014-01-01
影响因子：
2.8
通讯作者：
Witham, Timothy
中科院分区：
文献类型：
--
作者：
Chaichana, Kaisorn L.;Bydon, Mohamad;Witham, Timothy
物体。后路腰椎融合术治疗退行性脊柱疾病是一种常见的手术方式，其应用也在逐年增加。对于这些患者群体，感染率以及与感染风险增加相关的因素仍不清楚。更好地了解这些特征可能有助于指导旨在将这一相对常见的手术的感染降至最低的治疗策略。因此，作者的目标是确定术后脊柱感染的发生率，并确定与术后脊柱感染相关的因素。对1993-2010年间接受腰椎后路融合术治疗退行性脊柱疾病的成年患者的资料进行了回顾。采用逐步多元比例风险回归分析确定与感染相关的因素。P<；0.05的变量被认为具有统计学意义。在研究期间，连续817名患者因退行性脊柱疾病接受腰椎融合术，37名患者(4.5%)在术后平均0.6个月(IQR0.3-0.9)发生脊柱感染。与感染风险增加独立相关的因素有年龄增加(RR 1.004[95%CI 1.001-1.009]，p=0.049)、糖尿病(RR 5.583[95%CI 1.322-19.737]，p=0.02)、肥胖(RR 6.216[95%CI 1.832-9.338]，p=0.005)、既往脊柱手术(RR 2.994[95%CI 1.263-9.346]，p=0.009)，住院天数增加(RR 1.155[95%CI 1.076~1.230]，p=0.003)。在发生感染的37名患者中，21名(57%)需要手术干预，但只有3名(8%)需要取出器械作为感染管理的一部分。这项研究发现，在接受腰椎融合术治疗退行性脊柱疾病的患者中，年龄较大、糖尿病、肥胖、既往脊柱手术和住院时间等几个因素都与感染风险增加独立相关。这些患者中的绝大多数在不拆卸硬件的情况下得到了有效的治疗。
Object. Posterior lumbar spinal fusion for degenerative spine disease is a common procedure, and its use is increasing annually. The rate of infection, as well as the factors associated with an increased risk of infection, remains unclear for this patient population. A better understanding of these features may help guide treatment strategies aimed at minimizing infection for this relatively common procedure. The authors' goals were therefore to ascertain the incidence of postoperative spinal infections and identify factors associated with postoperative spinal infections.Methods. Data obtained in adult patients who underwent instrumented posterior lumbar fusion for degenerative spine disease between 1993 and 2010 were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify factors associated with infection. Variables with p < 0.05 were considered statistically significant.Results. During the study period, 817 consecutive patients underwent lumbar fusion for degenerative spine disease, and 37 patients (4.5%) developed postoperative spine infection at a median of 0.6 months (IQR 0.3-0.9). The factors independently associated with an increased risk of infection were increasing age (RR 1.004 [95% CI 1.001-1.009], p = 0.049), diabetes (RR 5.583 [95% CI 1.322-19.737], p = 0.02), obesity (RR 6.216 [95% CI 1.832-9.338], p = 0.005), previous spine surgery (RR 2.994 [95% CI 1.263-9.346], p = 0.009), and increasing duration of hospital stay (RR 1.155 [95% CI 1.076-1.230], p = 0.003). Of the 37 patients in whom infection developed, 21(57%) required operative intervention but only 3 (8%) required instrumentation removal as part of their infection management.Conclusions. This study identifies that several factors older age, diabetes, obesity, prior spine surgery, and length of hospital stay were each independently associated with an increased risk of developing infection among patients undergoing instrumented lumbar fusion for degenerative spine disease. The overwhelming majority of these patients were treated effectively without hardware removal.