Maragakis Lisa L, Cosgrove Sara E, Martinez Elizabeth A, Tucker Margaret G, Cohen David B, Perl Trish M
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Anesthesiology. 2009 Mar;110(3):556-62. doi: 10.1097/ALN.0b013e3181974be7.
Surgical site infections (SSI) after spinal surgery increase morbidity, mortality, length of hospital stay, and costs. Most previously identified risk factors for these infections, such as severity of illness and procedure duration, are not amenable to intervention. This study sought to identify modifiable risk factors associated with SSI after spinal surgery.
This is a case-control study including case identification and review of medical records. A total of 104 patients with SSI after spinal surgery were compared to 104 randomly selected control patients without SSI after spinal surgery in a 926-bed tertiary care hospital in Baltimore, Maryland, between April 1, 2001 and December 31, 2004.
Multivariate analysis identified independent risk factors for SSI after spinal surgery including prolonged procedure duration (odds ratio [OR], 4.7; 95% confidence interval [95% CI], 1.6-14; P < 0.001), American Society of Anesthesiologists score of 3 or greater (OR, 9.7; 95% CI, 3.7-25; P < 0.001), lumbar-sacral operative level (OR, 2.9; 95% CI, 1.2-7.1; P = 0.02), posterior approach (OR, 3.5; 95% CI, 1.2-9.7; P = 0.02), instrumentation (OR, 2.5; 95% CI, 1.1-6.0; P = 0.03), obesity (OR, 4.0; 94% CI, 1.6-10; P < 0.01), razor shaving before surgery (OR, 3.6; 95% CI, 1.2-11; P = 0.02), and intraoperative administered fraction of inspired oxygen of less than 50% (OR, 12; 94% CI, 4.5-33; P < 0.001).
In addition to previously reported risk factors, this study identified intraoperative administered fraction of inspired oxygen of less than 50% as an independent, modifiable risk factor for SSI after spinal surgery. Intraoperative administration of at least 50% fraction of inspired oxygen should be tested prospectively as an intervention to prevent SSI after spinal surgery.
脊柱手术后手术部位感染（SSI）会增加发病率、死亡率、住院时间并提高费用。此前确定的这些感染的大多数风险因素，如疾病严重程度和手术持续时间，都无法进行干预。本研究旨在确定与脊柱手术后SSI相关的可改变风险因素。
这是一项病例对照研究，包括病例识别和病历审查。在马里兰州巴尔的摩一家拥有926张床位的三级护理医院中，对2001年4月1日至2004年12月31日期间104例脊柱手术后发生SSI的患者与104例随机选择的未发生SSI的脊柱手术对照患者进行了比较。
多变量分析确定了脊柱手术后SSI的独立风险因素，包括手术持续时间延长（比值比[OR]，4.7；95%置信区间[95%CI]，1.6 - 14；P < 0.001）、美国麻醉医师协会评分为3分或更高（OR，9.7；95%CI，3.7 - 25；P < 0.001）、腰骶手术节段（OR，2.9；95%CI，1.2 - 7.1；P = 0.02）、后路手术（OR，3.5；95%CI，1.2 - 9.7；P = 0.02）、内固定（OR，2.5；95%CI，1.1 - 6.0；P = 0.03）、肥胖（OR，4.0；94%CI，1.6 - 10；P < 0.01）、术前剃毛（OR，3.6；95%CI，1.2 - 11；P = 0.02）以及术中吸入氧分数低于50%（OR，12；94%CI，4.5 - 33；P < 0.001）。
除了先前报道的风险因素外，本研究确定术中吸入氧分数低于50%是脊柱手术后SSI的一个独立、可改变的风险因素。术中给予至少50%的吸入氧分数作为预防脊柱手术后SSI的一种干预措施应进行前瞻性试验。
