Ramo Brandon A, Roberts David W, Tuason Dominick, McClung Anna, Paraison Lauren E, Moore Harold G, Sucato Daniel J
Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75209. E-mail address for B.A. Ramo:
J Bone Joint Surg Am. 2014 Dec 17;96(24):2038-48. doi: 10.2106/JBJS.N.00277.
Surgical site infection is a serious complication of posterior spinal fusion for neuromuscular scoliosis, with a reported prevalence of 6% to 24%. A single-institution experience over a thirty-year period was reviewed to determine the prevalence of surgical site infection after posterior spinal fusion for neuromuscular scoliosis, and to identify patient and treatment-related risk factors.
Our retrospective review included all patients treated with posterior spinal fusion (alone or in combination with an anterior procedure) for neuromuscular scoliosis from 1980 to 2009 and followed for a minimum of two years. Univariate and multivariate statistical analysis was performed to identify significant risk factors for occurrence of deep surgical site infection (p < 0.05).
The study included 428 patients with an average duration of follow-up of 4.9 years. The mean Cobb angle was 74.3°. Most (74%) were treated with posterior spinal fusion alone. Deep infection developed in forty-four patients (10.3%); 57% of the infections occurred within three months after the surgery and 73%, within twelve months. Nearly half (45%) of the infections were polymicrobial; 59% of the organisms were gram-positive and 41% were gram-negative. Implant removal was required in 58% of the patients. Surgical site infection was more frequent from 1980 to 1989 (20.3%) than it was from 1990 to 2009 (8.4%) (odds ratio [OR] = 2.8, p = 0.01 in univariate analysis). Surgical site infection was more common in patients with spina bifida (21.5%) than in those with other diagnoses (8.3%) (OR = 3.0, p = 0.001). Other patient factors associated with surgical site infection were a body mass index (BMI) of >25 kg/m(2) (OR = 2.4, p = 0.04) and incontinence (OR = 2.4, p = 0.009). Treatment factors associated with surgical site infection were inadequate prophylactic antibiotic dosing (cefazolin ≤ 20 mg/kg) (OR = 3.3, p = 0.0002), length of fusion (p = 0.002), pelvic fixation (OR = 2.4, p = 0.04), length of hospital stay (p = 0.005), and other complications (OR = 3.2, p = 0.0003). Drain output (p = 0.04) and lower hemoglobin levels (p = 0.008) were significantly associated with surgical site infection in patients with spina bifida, and drain use (superficial to the fascia) was protective in those without spina bifida (OR = 0.5, p = 0.046).
This study identified modifiable factors, especially antibiotic dosing and drain use, associated with surgical site infection in patients with neuromuscular scoliosis.
手术部位感染是神经肌肉型脊柱侧凸后路脊柱融合术的一种严重并发症，报道的发生率为6%至24%。回顾了一家机构三十年期间的经验，以确定神经肌肉型脊柱侧凸后路脊柱融合术后手术部位感染的发生率，并确定患者及治疗相关的危险因素。
我们的回顾性研究纳入了1980年至2009年期间接受后路脊柱融合术（单独或联合前路手术）治疗神经肌肉型脊柱侧凸且随访至少两年的所有患者。进行单因素和多因素统计分析以确定深部手术部位感染发生的显著危险因素（p<0.05）。
该研究纳入了428例患者，平均随访时间为4.9年。平均Cobb角为74.3°。大多数患者（74%）仅接受了后路脊柱融合术。44例患者（10.3%）发生了深部感染；57%的感染发生在术后三个月内，73%发生在十二个月内。近一半（45%）的感染为多种微生物感染；59%的病原体为革兰氏阳性菌，41%为革兰氏阴性菌。58%的患者需要取出植入物。1980年至1989年期间手术部位感染比1990年至2009年期间更频繁（20.3%比8.4%）（单因素分析中优势比[OR]=2.8，p=0.01）。脊柱裂患者的手术部位感染比其他诊断患者更常见（21.5%比8.3%）（OR=3.0，p=0.001）。与手术部位感染相关的其他患者因素包括体重指数（BMI）>25kg/m²（OR=2.4，p=0.04）和尿失禁（OR=2.4，p=0.009）。与手术部位感染相关的治疗因素包括预防性抗生素剂量不足（头孢唑林≤20mg/kg）（OR=3.3，p=0.0002）、融合长度（p=0.002）、骨盆固定（OR=2.4，p=0.04）、住院时间（p=0.005）和其他并发症（OR=3.2，p=0.0003）。脊柱裂患者的引流量（p=0.04）和较低的血红蛋白水平（p=0.008）与手术部位感染显著相关，而在无脊柱裂患者中使用引流（位于筋膜浅层）具有保护作用（OR=0.5，p=0.046）。
本研究确定了与神经肌肉型脊柱侧凸患者手术部位感染相关的可改变因素，尤其是抗生素剂量和引流的使用。
