Veeravagu Anand, Patil Chirag G, Lad Shivanand P, Boakye Maxwell
Stanford University School of Medicine, Stanford, CA, USA.
Spine (Phila Pa 1976). 2009 Aug 1;34(17):1869-72. doi: 10.1097/BRS.0b013e3181adc989.
This is a multivariate analysis of a prospectively collected database.
To determine preoperative, intraoperative, and patient characteristics that contribute to an increased risk of postoperative wound infection in patients undergoing spinal surgery.
Current literature sites a postoperative infection rate of approximately 4%; however, few have completed multivariate analysis to determine factors which contribute to risk of infection.
Our study identified patients who underwent a spinal decompression and fusion between 1997 and 2006 from the Veterans Affairs' National Surgical Quality Improvement Program database. Multivariate logistic regression analysis was used to determine the effect of various preoperative variables on postoperative infection.
Data on 24,774 patients were analyzed. Wound infection was present in 752 (3.04%) patients, 287 (1.16%) deep, and 468 (1.89%) superficial. Postoperative infection was associated with longer hospital stay (7.12 vs. 4.20 days), higher 30-day mortality (1.06% vs. 0.5%), higher complication rates (1.24% vs. 0.05%), and higher return to the operating room rates (37% vs. 2.45%). Multivariate logistic regression identified insulin dependent diabetes (odds ratios [OR] = 1.50), current smoking (OR = 1.19) ASA class of 3 (OR = 1.45) or 4 to 5 (OR = 1.66), weight loss (OR = 2.14), dependent functional status (1.36) preoperative HCT <36 (1.37), disseminated cancer (1.83), fusion (OR = 1.24) and an operative duration of 3 to 6 hours (OR = 1.33) or >6 hours (OR = 1.40) as statistically significant predictors of postoperative infection.
Using multivariate analysis of a large prospectively collected data from the National Surgical Quality Improvement Program database, we identified the most important risk factors for increased postoperative spinal wound infection. We have demonstrated the high mortality, morbidity, and hospitalization costs associated with postoperative spinal wound infections. The information provided should help alert clinicians to presence of these risks factors and the likelihood of higher postoperative infections and morbidity in spinal surgery patients.
这是对前瞻性收集的数据库进行的多变量分析。
确定脊柱手术患者术后伤口感染风险增加的术前、术中和患者特征。
当前文献报道术后感染率约为4%；然而，很少有人完成多变量分析以确定导致感染风险的因素。
我们的研究从退伍军人事务部国家外科质量改进计划数据库中识别出1997年至2006年间接受脊柱减压融合术的患者。采用多变量逻辑回归分析来确定各种术前变量对术后感染的影响。
分析了24774例患者的数据。752例（3.04%）患者发生伤口感染，其中287例（1.16%）为深部感染，468例（1.89%）为浅表感染。术后感染与住院时间延长（7.12天对4.20天）、30天死亡率较高（1.06%对0.5%）、并发症发生率较高（1.24%对0.05%）以及返回手术室率较高（37%对2.45%）相关。多变量逻辑回归确定胰岛素依赖型糖尿病（优势比[OR]=1.50）、当前吸烟（OR=1.19）、ASA分级为3级（OR=1.45）或4至5级（OR=1.66）、体重减轻（OR=2.14）、依赖性功能状态（1.36）、术前血细胞比容<36（1.37）、播散性癌症（1.83）、融合术（OR=1.24）以及手术持续时间为3至6小时（OR=1.33）或>6小时（OR=1.40）是术后感染的统计学显著预测因素。
通过对国家外科质量改进计划数据库中大量前瞻性收集的数据进行多变量分析，我们确定了术后脊柱伤口感染增加的最重要风险因素。我们已经证明了与术后脊柱伤口感染相关的高死亡率、发病率和住院费用。所提供的信息应有助于提醒临床医生注意这些风险因素的存在以及脊柱手术患者术后感染和发病率较高的可能性。
