Department of Orthopedic Surgery, Kaiser Permanente Orange County, Southern California Permanente Medical Group, 6670 Alton Parkway, Irvine, CA 92618, USA.
J Bone Joint Surg Am. 2013 May 1;95(9):775-82. doi: 10.2106/JBJS.L.00211.
Deep surgical site infection following total knee arthroplasty is a devastating complication. Patient and surgical risk factors for this complication have not been thoroughly examined. The purpose of this study was to evaluate risk factors associated with deep surgical site infection following total knee arthroplasty in a large U.S. integrated health-care system.
A retrospective review of a prospectively followed cohort of primary total knee arthroplasties recorded in a total joint replacement registry from 2001 to 2009 was conducted. Records were screened for deep surgical site infection with use of a validated algorithm, and the results were adjudicated by chart review. Patient factors, surgical factors, and surgeon and hospital characteristics were identified with use of the total joint replacement registry. Cox regression models were used to assess risk factors associated with deep surgical site infection.
A total of 56,216 total knee arthroplasties were identified; 63.0% were done in women, the average age of the patients was 67.4 years (standard deviation [SD] = 9.6), and the average body mass index (BMI) was 32 kg/m2 (SD = 6). The incidence of deep surgical site infection was 0.72% (404/56,216). In a fully adjusted model, patient factors associated with deep surgical site infection included a BMI of ≥35 (hazard ratio [HR] = 1.47), diabetes mellitus (HR = 1.28), male sex (HR = 1.89), an American Society of Anesthesiologists (ASA) score of ≥3 (HR = 1.65), a diagnosis of osteonecrosis (HR = 3.65), and a diagnosis of posttraumatic arthritis (HR = 3.23). Hispanic race was protective (HR = 0.69). Protective surgical factors included use of antibiotic irrigation (HR = 0.67), a bilateral procedure (HR = 0.51), and a lower annual hospital volume (HR = 0.33). Surgical risk factors included quadriceps-release exposure (HR = 4.76) and the use of antibiotic-laden cement (HR = 1.53). In a subanalysis, operative time was a risk factor, with a 9% increased risk per fifteen-minute increment.
Use of a comprehensive infection surveillance system, combined with a total joint replacement registry, identified patient and surgical factors associated with infection following total knee arthroplasty in a large sample. High-risk patients should be counseled, and modifiable clinical conditions should be optimized. Use of antibiotic irrigation should be encouraged, but antibiotic-laden cement may not be useful.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
全膝关节置换术后深部手术部位感染是一种破坏性的并发症。尚未彻底研究该并发症的患者和手术危险因素。本研究的目的是评估在美国综合医疗保健系统中，全膝关节置换术后深部手术部位感染的相关危险因素。
对 2001 年至 2009 年期间在关节置换登记处前瞻性随访的原发性全膝关节置换术队列进行回顾性审查。使用经过验证的算法筛查深部手术部位感染记录，并通过图表审查对结果进行裁决。使用关节置换登记处确定患者因素、手术因素以及外科医生和医院特征。使用 Cox 回归模型评估与深部手术部位感染相关的危险因素。
共确定了 56216 例全膝关节置换术；63.0%的手术为女性，患者平均年龄为 67.4 岁（标准差[SD] = 9.6），平均体重指数（BMI）为 32kg/m2（SD = 6）。深部手术部位感染的发生率为 0.72%（404/56216）。在完全调整模型中，与深部手术部位感染相关的患者因素包括 BMI≥35（风险比[HR] = 1.47）、糖尿病（HR = 1.28）、男性（HR = 1.89）、美国麻醉医师协会（ASA）评分≥3（HR = 1.65）、骨坏死（HR = 3.65）和创伤后关节炎（HR = 3.23）。西班牙裔为保护因素（HR = 0.69）。保护性手术因素包括使用抗生素冲洗（HR = 0.67）、双侧手术（HR = 0.51）和较低的年度医院容量（HR = 0.33）。手术危险因素包括股四头肌松解暴露（HR = 4.76）和使用载抗生素水泥（HR = 1.53）。在亚分析中，手术时间是一个危险因素，每增加 15 分钟，风险增加 9%。
使用综合感染监测系统和关节置换登记处相结合的方法，在大量样本中确定了与全膝关节置换术后感染相关的患者和手术因素。应告知高危患者，并优化可改变的临床条件。应鼓励使用抗生素冲洗，但载抗生素水泥可能没有用。
预后 II 级。请参阅作者说明，以获取完整的证据水平描述。
