College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee.
Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee.
Neurosurgery. 2018 Sep 1;83(3):508-520. doi: 10.1093/neuros/nyx478.
Shunt infections remain a significant challenge in pediatric neurosurgery. Numerous surgical checklists have been introduced to reduce infection rates.
To introduce an evidence-based shunt surgery checklist and its impact on our shunt infection rate.
Between January 1, 2008 and December 31, 2015, pediatric patients who underwent shunt surgery at our institution were indexed in a prospectively maintained database. All definitive shunt procedures were included. Shunt infection was defined according to the Center for Disease Control and Prevention's National Hospital Safety Network surveillance definition for surgical site infection. Clinical and procedural variables were abstracted per procedure. Infection data were compared for the 4 year before and 4 year after protocol implementation. Compliance was calculated from retrospective review of our checklists.
Over the 8-year study period, 1813 procedures met inclusion criteria with a total of 37 shunt infections (2%). Prechecklist (2008-2011) infection rate was 3.03% (28/924) and decreased to 1.01% (9/889; P = .003) postchecklist (2012-2015), representing an absolute risk reduction of 2.02% and relative risk reduction of 66.6%. One shunt infection was prevented for every 50 times the checklist was used. Those patients who developed an infection after protocol implementation were younger (0.95 years vs 3.40 years (P = .027)), but there were no other clinical or procedural variables, including time to infection, that were significantly different between the cohorts. Average compliance rate among required checklist components was 97% (range 85%-100%).
Shunt surgery checklist implementation correlated with lower infection rates that persisted in the 4 years after implementation.
分流感染仍然是小儿神经外科的一个重大挑战。已经引入了许多手术核对表来降低感染率。
介绍一种基于证据的分流手术核对表及其对我们的分流感染率的影响。
在 2008 年 1 月 1 日至 2015 年 12 月 31 日期间，我们机构的小儿患者索引被收录在一个前瞻性维护的数据库中。所有确定性分流手术都包括在内。分流感染根据疾病控制和预防中心国家医院安全网络监测手术部位感染的定义来定义。每例手术都提取临床和程序变量。感染数据在方案实施前 4 年和后 4 年进行比较。从我们的核对表的回顾性审查中计算了合规性。
在 8 年的研究期间，有 1813 例符合纳入标准，共发生 37 例分流感染（2%）。在核对表实施前（2008-2011 年）感染率为 3.03%（28/924），降至核对表实施后（2012-2015 年）的 1.01%（9/889；P=0.003），绝对风险降低 2.02%，相对风险降低 66.6%。每使用核对表 50 次就可预防 1 例感染。在方案实施后发生感染的患者年龄较小（0.95 岁 vs 3.40 岁（P=0.027）），但两组之间没有其他临床或程序变量（包括感染时间）存在显著差异。所需核对表组成部分的平均合规率为 97%（范围 85%-100%）。
分流手术核对表的实施与感染率降低相关，这种情况在实施后 4 年仍持续存在。
