Olsen Margaret A, Nepple Jeffrey J, Riew K Daniel, Lenke Lawrence G, Bridwell Keith H, Mayfield Jennie, Fraser Victoria J
Division of Infectious Diseases, Campus Box 8051, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2008 Jan;90(1):62-9. doi: 10.2106/JBJS.F.01515.
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.
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.
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).
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.
脊柱手术后手术部位感染并不罕见，且可能与严重的发病情况、死亡率及资源利用增加相关。准确识别风险因素对于制定预防这些潜在破坏性感染的策略至关重要。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风险因素。
我们对1998年至2002年在一所大学附属三级医疗医院接受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例发生浅表、深部或器官间隙手术部位感染的患者，并与227例未感染的对照患者进行比较。通过单因素分析和多因素逻辑回归确定手术部位感染的风险因素。
在研究的五年期间，脊柱手术部位感染的总体发生率为2.0%（2316例中的46例）。单因素分析显示，发生手术部位感染的患者术前及术后五天内的血糖水平显著高于未感染的对照患者。多因素分析确定的手术部位感染的独立风险因素包括糖尿病（比值比=3.5，95%置信区间=1.2，10.0）、预防性抗生素治疗时机欠佳（比值比=3.4，95%置信区间=1.5，7.9）、术前血糖水平>125mg/dL（>6.9mmol/L）或术后血糖水平>200mg/dL（>11.1mmol/L）（比值比=3.3，95%置信区间=1.4，7.5）、肥胖（比值比=2.2，95%置信区间=1.1，4.7）以及有两名或更多外科住院医师参与手术过程（比值比=2.2，95%置信区间=1.0，4.7）。颈椎手术与手术部位感染风险降低相关（比值比=0.3，95%置信区间=0.1，0.6）。
糖尿病与脊柱手术部位感染的独立风险最高相关，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。高血糖作为未先前诊断为糖尿病患者手术部位感染风险因素的作用应进一步研究。术前一小时内给予预防性抗生素以及根据肥胖情况增加抗生素剂量也是降低脊柱手术后手术部位感染风险的重要策略。
