Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Clin Orthop Relat Res. 2011 Sep;469(9):2621-30. doi: 10.1007/s11999-010-1737-2. Epub 2010 Dec 16.
Orthopaedic surgical-site infections prolong hospital stays, double rehospitalization rates, and increase healthcare costs. Additionally, patients with orthopaedic surgical-site infections (SSI) have substantially greater physical limitations and reductions in their health-related quality of life. However, the risk factors for SSI after operative fracture care are unclear.
QUESTIONS/PURPOSE: We determined the incidence and quantified modifiable and nonmodifiable risk factors for SSIs in patients with orthopaedic trauma undergoing surgery.
We retrospectively indentified, from our prospective trauma database and billing records, 1611 patients who underwent 1783 trauma-related procedures between 2006 and 2008. Medical records were reviewed and demographics, surgery-specific data, and whether the patients had an SSI were recorded. We determined which if any variables predicted SSI.
Six factors independently predicted SSI: (1) the use of a drain, OR 2.3, 95% CI (1.3-3.8); (2) number of operations OR 3.4, 95% CI (2.0-6.0); (3) diabetes, OR 2.1, 95% CI (1.2-3.8); (4) congestive heart failure (CHF), OR 2.8, 95% CI (1.3-6.5); (5) site of injury tibial shaft/plateau, OR 2.3, 95% CI (1.3-4.2); and (6) site of injury, elbow, OR 2.2, 95% CI (1.1-4.7).
The risk factors for SSIs after skeletal trauma are most strongly determined by nonmodifiable factors: patient infirmity (diabetes and heart failure) and injury complexity (site of injury, number of operations, use of a drain).
Level II, prognostic study. See the Guideline for Authors for a complete description of levels of evidence.
矫形外科手术部位感染会延长住院时间，使再次住院率增加一倍，并增加医疗保健成本。此外，患有矫形外科手术部位感染（SSI）的患者身体活动受限明显更大，生活质量相关健康状况下降。然而，手术治疗骨折后 SSI 的风险因素尚不清楚。
问题/目的：我们确定了接受矫形创伤手术的患者 SSI 的发生率，并量化了可改变和不可改变的危险因素。
我们从我们的前瞻性创伤数据库和计费记录中回顾性地确定了 2006 年至 2008 年间接受 1783 次与创伤相关手术的 1611 名患者。回顾了病历，并记录了人口统计学、手术具体数据以及患者是否发生 SSI。我们确定了哪些变量可以预测 SSI。
有六个因素独立预测 SSI：（1）使用引流管，OR2.3，95%CI（1.3-3.8）；（2）手术次数 OR3.4，95%CI（2.0-6.0）；（3）糖尿病，OR2.1，95%CI（1.2-3.8）；（4）充血性心力衰竭（CHF），OR2.8，95%CI（1.3-6.5）；（5）损伤部位胫骨骨干/平台，OR2.3，95%CI（1.3-4.2）；和（6）损伤部位，肘部，OR2.2，95%CI（1.1-4.7）。
骨骼创伤后 SSI 的危险因素主要由不可改变的因素决定：患者体弱（糖尿病和心力衰竭）和损伤复杂性（损伤部位、手术次数、引流管的使用）。
II 级，预后研究。有关证据水平的完整描述，请参阅作者指南。
