Department of Orthopedic Surgery, Spine Unit, Centre Hopitalier de l'Université de Montréal (CHUM), 264 Boulevard René-Lévesque E, Montréal, Quebec H2X 1P1, Canada; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Department of Neurosurgery, Spine Unit, Centre Hopitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
Spine J. 2018 Aug;18(8):1382-1387. doi: 10.1016/j.spinee.2018.01.002. Epub 2018 Jan 31.
Surgical site infection (SSI) in spinal metastasis surgery represents the most common postoperative surgical complication with high morbidity and mortality.
This study aims to evaluate the incidence of SSI in spinal metastasis surgery and its risk factors.
This is a retrospective analysis of a prospectively collected data.
Preoperative, operative, and postoperative data were collected together with the modified Tokuhashi score and Frankel score at all time checkpoints. Surgical site infection was divided into superficial and deep SSI, as well as early (<90 days) and late SSI. Multiple logistic regression analysis was performed to identify independent risk factors, with p<.05 as significance threshold.
A total of 297 patients were included, with an incidence of SSI of 5.1% (superficial SSI: 3.4%; deep SSI: 1.7 %). Cervicothoracic surgery was associated with the highest incidence of SSI, whereas cervical surgery had the lowest incidence. Smoking, higher number of spinal metastasis, elevated body mass index (BMI), and higher ASA (American Society of Anesthesiologist) score were the preoperative factors associated with increased risk of SSI. Increased intraoperative blood loss and increased number of fixed vertebra increased the SSI incidence. SSI increased hospital stay by a mean of 12 days. When all these variables are analyzed in a multiple regression model, only surgical time≥4 hours and ASA≥3 were found to be independent risk factors for the occurrence of SSI.
This paper represents the largest series of spinal metastasis with a mean incidence of SSI of 5.1%. Smoking, higher BMI, higher number of spinal metastasis, higher ASA score, higher number of fused vertebra, intraoperative bleeding≥2000 mL, and neurologic deterioration are risk factors for SSI occurrence. Only ASA≥3 and operative duration≥4 hours are independent risk factors for this complication occurrence. Finally, SSI occurrence is associated with increased hospital stay, increased 30-day mortality rate, and decreased survival rates.
脊柱转移瘤术后手术部位感染（SSI）是最常见的术后手术并发症，发病率和死亡率均较高。
本研究旨在评估脊柱转移瘤手术中 SSI 的发生率及其危险因素。
这是一项前瞻性收集数据的回顾性分析。
收集所有时间点的术前、术中和术后数据，以及改良 Tokuhashi 评分和 Frankel 评分。将手术部位感染分为浅部和深部 SSI，以及早期（<90 天）和晚期 SSI。采用多因素逻辑回归分析确定独立危险因素，以 p<.05 为显著性阈值。
共纳入 297 例患者，SSI 发生率为 5.1%（浅部 SSI：3.4%；深部 SSI：1.7%）。颈椎胸段手术的 SSI 发生率最高，而颈椎手术的 SSI 发生率最低。吸烟、脊柱转移瘤数量较多、体质量指数（BMI）升高和美国麻醉医师协会（ASA）评分升高是 SSI 风险增加的术前因素。术中出血量增加和固定的椎骨数量增加均增加 SSI 发生率。SSI 使住院时间平均延长 12 天。当将所有这些变量纳入多因素回归模型分析时，只有手术时间≥4 小时和 ASA≥3 被发现是 SSI 发生的独立危险因素。
本文是最大系列的脊柱转移瘤病例，SSI 的平均发生率为 5.1%。吸烟、BMI 较高、脊柱转移瘤数量较多、ASA 评分较高、融合的椎骨数量较多、术中出血量≥2000 mL 以及神经功能恶化是 SSI 发生的危险因素。只有 ASA≥3 和手术时间≥4 小时是该并发症发生的独立危险因素。最后，SSI 的发生与住院时间延长、30 天死亡率增加和生存率降低有关。
