Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Spine (Phila Pa 1976). 2012 Sep 1;37(19):1652-6. doi: 10.1097/BRS.0b013e318241b186.
A retrospective review.
The purpose of this study was to determine the role in body habitus and weight distribution on developing a surgical site infection (SSI).
SSI after lumbar spine surgery remains a significant cause of morbidity. The literature demonstrates an increased risk of postoperative infections associated with obesity, diabetes, and multilevel surgeries.
A retrospective review was performed on a consecutive cohort of 298 adult patients who underwent lumbar spine fusion surgeries between 2006 and 2008 at the Duke University Medical Center. Previously identified risk factors (i.e., number of levels, diabetes, body mass index [BMI]) were collected, as well as the horizontal distance from the lamina to the skin surface (measured at L4) and thickness of subcutaneous fat at the surgical site.
Among the 298 patients, 24 (8%) had postoperative infections. Of the previously identified risk factors, number of levels (P = 0.0078) was found to be significantly associated with infections, whereas BMI (P = 0.16) and diabetes (P = 0.13) were found not to be statistically significant. Obesity (BMI ≥30) (P = 0.025), skin to lamina distance (P = 0.046), and thickness of the subcutaneous fat (P = 0.035) were found to be significant risk factors for SSI.
Our findings suggest that in obese patients, the distribution of body mass is more predictive of SSI than the absolute BMI and deserves attention in preoperative evaluation.
回顾性研究。
本研究旨在确定身体形态和体重分布在发生手术部位感染（SSI）中的作用。
腰椎手术后的 SSI 仍然是发病率的一个重要原因。文献表明，肥胖、糖尿病和多节段手术与术后感染的风险增加有关。
对 2006 年至 2008 年在杜克大学医学中心接受腰椎融合手术的 298 例成年患者的连续队列进行了回顾性研究。收集了先前确定的危险因素（即手术节段数、糖尿病、体重指数[BMI]），以及从椎板到皮肤表面的水平距离（在 L4 处测量）和手术部位的皮下脂肪厚度。
在 298 例患者中，有 24 例（8%）发生术后感染。在先前确定的危险因素中，手术节段数（P=0.0078）与感染显著相关，而 BMI（P=0.16）和糖尿病（P=0.13）与感染无统计学意义。肥胖（BMI≥30）（P=0.025）、皮肤到椎板距离（P=0.046）和皮下脂肪厚度（P=0.035）是 SSI 的显著危险因素。
我们的研究结果表明，在肥胖患者中，体重分布比绝对 BMI 更能预测 SSI，这在术前评估中值得关注。
