Verma Kushagra, Lonner Baron, Dean Laura, Vecchione David, Kean Kathryn
Bull Hosp Jt Dis (2013). 2013;71(4):257-64.
Numerous studies have reported on post- operative infection following spinal arthrodesis for spinal deformity. The incidence of infection associated with spinal surgery overall ranges from less than 1% to 15%. Certain factors may increase the risk of surgical site infection (SSI) in patients who undergo surgical treatment for spinal deformities. These include a diagnosis of neuromuscular disease, use of surgical drain or lack thereof, patient comorbidities, increased blood transfusions, and an allergic inflammatory response to the use of instrumentation. Many of these studies, however, have been limited by small numbers and confounded by multiple surgeons and hospitals.
The purpose of this study was to determine the rate of spinal wound infection following spinal deformity surgery in a single surgeon's practice and to identify risk factors for infection, particularly those related to type of deformity and surgical procedures performed.
This is a retrospective review of prospectively collected data from a single surgeon. Only spinal deformity patients' records were reviewed.
We reviewed 941 spinal deformity operative procedures (806 patients, 584 females, 222 males) done by a single surgeon from 1999 to 2009. Outcome measures were superficial wound infection, deep wound infection, possible infection, and no infection. The following variables were assessed: gender, age, height, weight, body mass index (BMI), primary diagnosis, associated comorbidities, prior spinal surgeries, surgical approach, type and number of procedures performed, radiographic measurements, operative data (including operative time), and complications. A one-way ANOVA and Turkey post-hoc analysis was used.
The average age was 22.3 years (range 1.8 to 82 years). There were 13 deep wound infections (1.4%) and 17 incidences of superficial wound infection (1.8%), for an overall infection rate of 3.2%. The following variables were found to be independent predictors of deep infection: neuromuscular scoliosis (odd ratio (O.R. 9.2) and Lenke 3 or 4 curve types in adolescent idiopathic scoliosis patients (O.R. 7.4). Kyphosis (O.R. 4.38), combined approach (O.R. 0.81), total number of levels fused (O.R. 1.16), and Lenke 3 or 4 curve types in AIS (O.R. 4.54) were independent predictors of superficial infection. Lastly, logistic regression identified the following as predictors of any infection: BMI (O.R. 1.11), total number of comorbidities (O.R. 1.24), osteotomy procedure (O.R. 3.14), number of levels fused (O.R. 1.13), and Lenke 3 or 4 curve types (O.R. 1.67).
Age, BMI, number of levels, Lenke 3-4 curves, osteotomy, and number of comorbidities were found to be predictors of any infection. Of these, only Lenke 3-4 and neuromuscular comorbidity was correlated with deep infection.
众多研究报道了脊柱畸形脊柱融合术后的手术感染情况。脊柱手术总体感染发生率从不足1%到15%不等。对于接受脊柱畸形手术治疗的患者，某些因素可能会增加手术部位感染（SSI）的风险。这些因素包括神经肌肉疾病诊断、是否使用手术引流管、患者合并症、输血增加以及对器械使用的过敏炎症反应。然而，许多此类研究因样本量小且受到多名外科医生和多家医院的干扰而存在局限性。
本研究的目的是确定在单一外科医生的实践中脊柱畸形手术后脊柱伤口感染的发生率，并确定感染的危险因素，特别是那些与畸形类型和所施行的手术程序相关的因素。
这是一项对单一外科医生前瞻性收集的数据进行的回顾性研究。仅回顾了脊柱畸形患者的记录。
我们回顾了1999年至2009年期间由一名外科医生实施的941例脊柱畸形手术（806例患者，584例女性，222例男性）。结果指标为表浅伤口感染、深部伤口感染、可能感染和无感染。评估了以下变量：性别、年龄、身高、体重、体重指数（BMI）、初步诊断、相关合并症、既往脊柱手术、手术入路、所施行手术的类型和数量、影像学测量、手术数据（包括手术时间）以及并发症。采用单因素方差分析和Turkey事后分析。
平均年龄为22.3岁（范围为1.8至82岁）。有13例深部伤口感染（1.4%）和17例表浅伤口感染（1.8%），总体感染率为3.2%。发现以下变量是深部感染的独立预测因素：神经肌肉型脊柱侧凸（比值比（O.R.）9.2）以及青少年特发性脊柱侧凸患者中的Lenke 3或4型曲线（O.R. 7.4）。后凸畸形（O.R. 4.38）、联合入路（O.R. 0.81）、融合节段总数（O.R. 1.16）以及青少年特发性脊柱侧凸中的Lenke 3或4型曲线（O.R. 4.54）是表浅感染的独立预测因素。最后，逻辑回归确定以下因素为任何感染的预测因素：BMI（O.R. 1.11）、合并症总数（O.R. 1.24）、截骨手术（O.R. 3.14）、融合节段数（O.R. 1.13）以及Lenke 3或4型曲线（O.R. 1.67）。
年龄、BMI、节段数、Lenke 3 - 4型曲线、截骨手术和合并症数量被发现是任何感染的预测因素。其中，只有Lenke 3 - 4型曲线和神经肌肉合并症与深部感染相关。
