Haddad Sleiman, Millhouse Paul W, Maltenfort Mitchell, Restrepo Camilo, Kepler Christopher K, Vaccaro Alexander R
Universitat Autonoma de Barcelona (UAB), Facultat de Medicina UD Vall d'Hebron - Edifici W Universitat Autònoma de Barcelona Pg. de la Vall d'Hebron, 119-129, Barcelona, Catalonia, Spain; Departament de Cirugia Ortopedica I Traumatologia, Vall d'Hebron University Hospital, Area de Traumatologia, Pg. de la Vall d'Hebron, 119-129, Barcelona, Catalonia, Spain; Rothman Institute, 925 Chestnut Street, 5th Floor, Rothman Institute at Jefferson, Philadelphia, PA 19107, USA.
Rothman Institute, 925 Chestnut Street, 5th Floor, Rothman Institute at Jefferson, Philadelphia, PA 19107, USA.
Spine J. 2016 May;16(5):632-42. doi: 10.1016/j.spinee.2016.01.019. Epub 2016 Jan 22.
Surgical site infection (SSI) incidence after cervical spinal surgery ranges from 0.1% to 17%. Although the general risk factors for SSI have been discussed, the relationship of neurologic status and trauma to SSI has not been explicitly explored.
This study aimed to study associated risk factors and to report the incidence of SSI in patients who have undergone cervical spinal surgery with the following four preoperative diagnoses: (1) degenerative disease with no myelopathy (MP), (2) degenerative disease with MP, (3) traumatic cervical injury without spinal cord injury (SCI), (4) traumatic cervical injury with SCI. We hypothesize that SSI incidence would increase from Group (1) to Group (4).
Retrospective database analysis was carried out.
We used International Classification of Diseases codes to identify the four groups of patients in the U.S. Nationwide Inpatient Sample (NIS) from the years 2000 to 2011. We complemented this study with a similar search in our institutional database (ID) from the years 2000 to 2013. Patients with concomitant congenital deformity, infection, inflammatory disease, and neoplasia were excluded, as were revision surgeries.
The primary outcome studied was the occurrence of SSI. Statistical analyses included bivariate comparisons and chi-square distribution of demographic data and multivariable regression for demographic, surgical, and outcome variables.
A total of 1,247,281 and 5,540 patients met inclusion criteria in the NIS database and the ID, respectively. Overall SSI incidence was 0.73% (NIS) versus 1.75% (ID). Surgical site infection incidence increased steadily from 0.52% in Group (1) to 1.97% in Group (4) in the NIS data and from 0.88% to 5.54% in the ID. Differences between diagnostic groups and cohorts reached statistical significance. Surgical site infection was predicted significantly by status (odds ratio [OR] 1.69, p<.0001) and trauma (OR 1.30, p=.0003) in the NIS data. Other significant predictors included the following: approach, number of levels fused, female gender, black race, medium size hospital, rural hospital, large hospital, western US hospital and Medicare coverage. In the ID, only trauma (OR 2.11, p=.03) reached significance when accounting for comorbidities.
Both primary diagnosis (trauma vs. degenerative) and neurologic status (MP or SCI) were found to be strong and independent predictors of SSI in cervical spine surgery.
颈椎手术后手术部位感染（SSI）的发生率在0.1%至17%之间。虽然已经讨论了SSI的一般危险因素，但神经状态和创伤与SSI的关系尚未得到明确探讨。
本研究旨在研究相关危险因素，并报告接受颈椎手术的患者中SSI的发生率，这些患者术前有以下四种诊断：（1）无脊髓病（MP）的退行性疾病，（2）有MP的退行性疾病，（3）无脊髓损伤（SCI）的创伤性颈椎损伤，（4）有SCI的创伤性颈椎损伤。我们假设SSI发生率会从第（1）组到第（4）组逐渐增加。
进行回顾性数据库分析。
我们使用国际疾病分类代码在美国全国住院患者样本（NIS）中识别2000年至2011年的四组患者。我们在2000年至2013年的机构数据库（ID）中进行了类似的搜索，以补充本研究。排除伴有先天性畸形、感染、炎症性疾病和肿瘤的患者，以及翻修手术患者。
研究的主要观察指标是SSI的发生情况。统计分析包括人口统计学数据的双变量比较和卡方分布，以及人口统计学、手术和观察指标变量的多变量回归分析。
NIS数据库和ID中分别有1,247,281例和5,540例患者符合纳入标准。总体SSI发生率在NIS数据库中为0.73%，在ID中为1.75%。在NIS数据中，手术部位感染发生率从第（1）组的0.52%稳步上升至第（4）组的1.97%，在ID中从0.88%上升至5.54%。诊断组和队列之间的差异具有统计学意义。在NIS数据中，状态（优势比[OR]1.69，p<0.0001）和创伤（OR 1.30，p = 0.0003）是SSI的显著预测因素。其他显著预测因素包括：手术入路、融合节段数、女性、黑人种族、中等规模医院、农村医院、大型医院、美国西部医院和医疗保险覆盖情况。在ID中，在考虑合并症时，只有创伤（OR 2.11，p = 0.03）具有统计学意义。
在颈椎手术中，主要诊断（创伤与退行性疾病）和神经状态（MP或SCI）均被发现是SSI的强大且独立的预测因素。
