Apisarnthanarak Anucha, Jones Marilyn, Waterman Brian M, Carroll Cathy M, Bernardi Robert, Fraser Victoria J
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Infect Control Hosp Epidemiol. 2003 Jan;24(1):31-6. doi: 10.1086/502112.
To characterize risk factors for surgical-site infection after spinal surgery.
A case-control study.
A 113-bed community hospital.
From January 1998 through June 2000, the incidence of surgical-site infection in patients undergoing laminectomy, spinal fusion surgery, or both increased at community hospital A. We compared 13 patients who acquired surgical-site infections after laminectomy, spinal fusion surgery, or both with 47 patients who were operated on during the same time period but did not acquire a surgical-site infection. Information collected included demographics, risk factors, personnel involved in the operations, length of hospital stay, and hospital costs.
Of 13 case-patients, 9 (69%) were obese, 9 (69%) had spinal compression, 5 (38.5%) had a history of tobacco use, and 4 (31%) had diabetes. Oxacillin-sensitive Staphylococcus aureus (6 of 13; 46%) was the most common organism isolated. Significant risk factors for postoperative spinal surgical-site infection were dural tear during the surgical procedure and the use of glue to cement the dural patch (3 of 13 [23%] vs 1 of 47 [2.1%]; P = .02) and American Society of Anesthesiologists risk class of 3 or more (6 of 13 [46.2%] vs 7 of 47 [15%]; P = .02). Case-patients were more likely to have prolonged length of stay (median, 16 vs 4 days; P< .001). The average excess length of stay was 11 days and the excess cost per case was $12,477.
Dural tear and the use of glue should be evaluated as potential risk factors for spinal surgical-site infection. Systematic observation for potential lapses in sterile technique and surgical processes that may increase the risk of infection may help prevent spinal surgical-site infection.
明确脊柱手术后手术部位感染的危险因素。
病例对照研究。
一家拥有113张床位的社区医院。
1998年1月至2000年6月期间，社区医院A接受椎板切除术、脊柱融合手术或两者皆有的患者手术部位感染发生率上升。我们将13例在椎板切除术、脊柱融合手术或两者皆有后发生手术部位感染的患者与47例在同一时期接受手术但未发生手术部位感染的患者进行了比较。收集的信息包括人口统计学资料、危险因素、参与手术的人员、住院时间和住院费用。
13例病例患者中，9例（69%）肥胖，9例（69%）有脊柱受压，5例（38.5%）有吸烟史，4例（31%）有糖尿病。分离出的最常见病原体是对苯唑西林敏感的金黄色葡萄球菌（13例中的6例；46%）。术后脊柱手术部位感染的显著危险因素是手术过程中的硬脊膜撕裂以及使用胶水固定硬脊膜补片（13例中的3例[23%] vs 47例中的1例[2.1%]；P = 0.02）和美国麻醉医师协会风险分级为3级或更高（13例中的6例[46.2%] vs 47例中的7例[15%]；P = 0.02）。病例患者更有可能住院时间延长（中位数，16天对4天；P < 0.001）。平均额外住院时间为11天，每例额外费用为12,477美元。
硬脊膜撕裂和胶水的使用应作为脊柱手术部位感染的潜在危险因素进行评估。对可能增加感染风险的无菌技术和手术过程中的潜在失误进行系统观察，可能有助于预防脊柱手术部位感染。
