Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA.
Spine (Phila Pa 1976). 2011 Aug 1;36(17):1410-9. doi: 10.1097/BRS.0b013e3181f48fa9.
We conducted a retrospective, case control study on patients undergoing surgery for spinal tumors. OBJECTIVE.: Our aim was to determine the incidence and to identify risk factors for surgical site infections (SSIs) in patients undergoing surgery for spinal tumors.
SSIs after spinal tumor surgery may be particularly devastating as they may add to substantial surgical morbidity and may further exacerbate already existing neurologic deficits. Incidence and risk factors predisposing to SSIs in patients undergoing surgery for spinal tumors are not well studied yet.
Between January 1995 and February 2008, 971 procedures for spinal tumors were performed on 739 patients. Excluding sacral tumors from the current study, 895 procedures on 678 patients were reviewed to identify those cases with SSIs. Furthermore, 65 infected cases and a randomly selected subset of 162 controls were analyzed by logistic regression modeling to identify the risk factors associated with SSIs.
There were 678 patients that were included in this study with 364 men (54%) and 314 women (46%), with an average age of 47.2 year. Sixty-five patients who developed SSIs underwent a total of 162 procedures including 78 procedures for wound debridement and washout. The incidence of SSIs was 8.89% for primary nonbony spinal tumors, 9.5% for metastatic spinal tumors, and 13.7% for primary bony spinal tumors. Staphylococcus aureus was the most commonly isolated organism (n = 22 of 65, 33%). In the multivariate logistic regression model, previous spinal surgeries, complex plastic closures, increasing number of comorbidities, presence of a hospital acquired infection at the time of a previous surgery, and increasing duration of hospital stay during primary surgery were significantly associated with increased likelihood of developing postoperative SSIs.
Surgery for spine tumors appears to be associated with a higher incidence of SSI than nontumor spine surgery. Identification of perioperative risk factors will help delineate this subset of patients with high risk for developing SSIs thus potentially allowing perioperative modification for such factors, which may lead to an overall better clinical outcome and patient satisfaction.
我们对接受脊柱肿瘤手术的患者进行了回顾性病例对照研究。
我们的目的是确定脊柱肿瘤手术患者中手术部位感染（SSI）的发生率并确定其危险因素。
脊柱肿瘤手术后发生 SSI 可能特别具有破坏性，因为它们可能会增加大量手术发病率，并可能进一步加重已经存在的神经功能缺损。脊柱肿瘤手术后发生 SSI 的发病率和易患因素尚未得到很好的研究。
1995 年 1 月至 2008 年 2 月，对 739 例患者的 971 例脊柱肿瘤手术进行了回顾性分析。将骶骨肿瘤排除在当前研究之外，对 678 例患者的 895 例手术进行了回顾，以确定发生 SSI 的病例。此外，通过逻辑回归模型对 65 例感染病例和随机选择的 162 例对照进行了分析，以确定与 SSI 相关的危险因素。
本研究共纳入 678 例患者，其中男性 364 例（54%），女性 314 例（46%），平均年龄为 47.2 岁。发生 SSI 的 65 例患者共进行了 162 次手术，其中 78 次进行了清创和冲洗。原发性非骨脊柱肿瘤的 SSI 发生率为 8.89%，转移性脊柱肿瘤为 9.5%，原发性骨脊柱肿瘤为 13.7%。金黄色葡萄球菌是最常见的分离菌（65 例中的 22 例，33%）。在多变量逻辑回归模型中，既往脊柱手术、复杂的整形闭合术、合并症数量增加、上一次手术时存在医院获得性感染以及原发性手术期间住院时间延长与术后 SSI 发生率增加显著相关。
与非肿瘤脊柱手术相比，脊柱肿瘤手术似乎与更高的 SSI 发生率相关。确定围手术期危险因素将有助于确定具有发生 SSI 高风险的患者亚组，从而有可能针对这些因素进行围手术期调整，从而可能获得整体更好的临床结果和患者满意度。
