Subramanyam Rajeev, Schaffzin Joshua, Cudilo Elizabeth M, Rao Marepalli B, Varughese Anna M
Department of Anesthesiology and Department of Pediatrics, 3333 Burnet Ave, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
Department of Pediatrics, Hospital Medicine, 3333 Burnet Ave, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Spine J. 2015 Jun 1;15(6):1422-31. doi: 10.1016/j.spinee.2015.03.005. Epub 2015 Mar 18.
Risk factors for surgical site infection (SSI) in children derived from the studies in the adult population are potentially misleading because of differences in pathophysiology and management.
This systematic review addresses the key question: What are the risk factors for SSI in pediatric patients undergoing scoliosis surgery?
This is a qualitative systematic literature review.
Retrospective and observational trials of children undergoing scoliosis surgery reported on the occurrence of risk factors for SSI and the occurrence of SSI.
Pubmed (Medline), Ovid Evidence-Based Medicine Reviews (EBMR), Scopus, and Cumulative Index to Nursing and Allied Health (CINAHL) were searched electronically for relevant articles in all the languages between January 1, 1991 and August 27, 2012, and cross-references were checked. Two independent reviewers identified articles and appraised quality with the Agency for Healthcare Research and Quality (AHRQ) criteria based on a weighted scoring of 0 to 100.
Our search identified 135 abstracts and 14 studies meeting the inclusion criteria. The AHRQ grading showed that five articles were high quality with a score of greater than 67, and five articles were moderate quality with a score between 50 and 67. The percent agreement between the two independent reviewers was 84%, and kappa agreement score was 0.91 (95% confidence interval [CI]: 0.78-1.03). There were 76 risk factors identified, of which 22 factors were reported in more than one study. Odds ratios and 95% CIs were reported inconsistently. Pooled p analysis of high- and moderate-quality articles identified five risk factors predictive of SSI: inappropriate antibiotic use (p=.001), neuromuscular scoliosis (p=.014), instrumentation (p=.023), increased hospital stay days (p=.003), and residual postoperative curve (p=.003).
The systematic review identified inappropriate antibiotic use, neuromuscular scoliosis, instrumentation, increased hospital stay days, and residual postoperative curve as risk factors for SSI after pediatric scoliosis surgery.
由于病理生理学和治疗方法存在差异，源于成人研究的儿童手术部位感染（SSI）风险因素可能会产生误导。
本系统评价旨在解决关键问题：接受脊柱侧弯手术的儿科患者发生SSI的风险因素有哪些？
这是一项定性系统文献综述。
对接受脊柱侧弯手术儿童的回顾性和观察性试验，报告了SSI风险因素的发生情况及SSI的发生情况。
通过电子检索PubMed（Medline）、Ovid循证医学综述（EBMR）、Scopus以及护理与联合健康累积索引（CINAHL），查找1991年1月1日至2012年8月27日期间所有语言的相关文章，并核对参考文献。两名独立评审员根据医疗保健研究与质量局（AHRQ）的标准，通过0至100的加权评分来识别文章并评估质量。
我们的检索共识别出135篇摘要和14项符合纳入标准的研究。AHRQ分级显示，5篇文章质量高，得分大于67，5篇文章质量中等，得分在50至67之间。两名独立评审员之间的百分比一致性为84%，kappa一致性评分为0.91（95%置信区间[CI]：0.78 - 1.03）。共识别出76个风险因素，其中22个因素在不止一项研究中被报告。优势比和95%CI的报告不一致。对高质量和中等质量文章进行的合并p分析确定了5个预测SSI的风险因素：抗生素使用不当（p = 0.001）、神经肌肉型脊柱侧弯（p = 0.014）、内固定（p = 0.023）、住院天数增加（p = 0.003）以及术后残留侧弯（p = 0.003）。
该系统评价确定了抗生素使用不当、神经肌肉型脊柱侧弯、内固定、住院天数增加以及术后残留侧弯是小儿脊柱侧弯手术后发生SSI的风险因素。
