Werner Brian C, Teran Victor A, Deal D Nicole
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
J Hand Surg Am. 2018 Mar;43(3):214-219. doi: 10.1016/j.jhsa.2017.09.017. Epub 2017 Oct 18.
To establish the rate of postoperative infection after open carpal tunnel release (CTR) on a national level using an administrative database and define relevant patient-related risk factors associated with its occurrence.
The PearlDiver patient records database was used to query the 100% Medicare Standard Analytic Files retrospectively from 2005 to 2012 for patients undergoing open CTR using Current Procedural Terminology code 64721. Postoperative infection within 90 days of surgery was assessed using both International Classification of Diseases, Ninth Revision codes for diagnoses of postoperative infection or pyogenic arthritis of the wrist and Current Procedural Terminology codes for procedures for these indications, including either open or arthroscopic irrigation and debridement. We used a multivariable binomial logistic regression model that allows for assessment of the independent effect of a variable while controlling for remaining variables to evaluate which patient demographics and medical comorbidities were associated with an increased risk for postoperative infection. Adjusted odds ratios and 95% confidence intervals were calculated for each risk factor, with P < .05 considered statistically significant.
A total of 454,987 patients met all inclusion and exclusion criteria. Of these patients, 1,466 developed a postoperative infection, corresponding to an infection rate of 0.32%. Independent positive risk factors for infection included younger age, male sex, obesity (body mass index of 30 to 40), morbid obesity (body mass index greater than 40), tobacco use, alcohol use, and numerous medical comorbidities including diabetes, inflammatory arthritis, peripheral vascular disease, chronic liver disease, chronic kidney disease, chronic lung disease, and depression.
The current study reinforced conventional wisdom regarding the the overall low infection rate after CTR and revealed numerous patient-related risk factors that are independently associated with an increased risk of infection after open CTR in patients enrolled in Medicare.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
利用行政数据库在全国范围内确定开放性腕管松解术（CTR）术后感染率，并确定与其发生相关的患者相关危险因素。
使用PearlDiver患者记录数据库，从2005年至2012年对100%的医疗保险标准分析文件进行回顾性查询，以获取使用当前程序术语代码64721进行开放性CTR的患者。使用国际疾病分类第九版代码诊断术后感染或手腕化脓性关节炎，以及使用当前程序术语代码进行这些适应症的手术，包括开放性或关节镜下冲洗和清创，来评估术后90天内的感染情况。我们使用多变量二项逻辑回归模型，在控制其余变量的同时评估变量的独立效应，以评估哪些患者人口统计学特征和医疗合并症与术后感染风险增加相关。计算每个危险因素的调整比值比和95%置信区间，P < .05被认为具有统计学意义。
共有454,987名患者符合所有纳入和排除标准。在这些患者中，1466例发生了术后感染，感染率为0.32%。感染的独立阳性危险因素包括年龄较小、男性、肥胖（体重指数为30至40）、病态肥胖（体重指数大于40）、吸烟、饮酒以及多种医疗合并症，包括糖尿病、炎性关节炎、外周血管疾病、慢性肝病、慢性肾病、慢性肺病和抑郁症。
本研究强化了关于CTR术后总体感染率较低的传统观念，并揭示了许多与患者相关的危险因素，这些因素与参加医疗保险的患者开放性CTR术后感染风险增加独立相关。
研究类型/证据水平：预后性研究II级。
