Falowski Steven M, Provenzano David A, Xia Ying, Doth Alissa H
St. Luke's University Health Network, Bethlehem, PA, USA.
Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
Neuromodulation. 2019 Feb;22(2):179-189. doi: 10.1111/ner.12843. Epub 2018 Aug 17.
Surgical site infections can cause negative clinical and economic outcomes. A recent international survey on Spinal Cord Stimulation (SCS) infection control practices demonstrated low compliance with evidence-based guidelines. This study defines infection rate for SCS implants and identifies infection risk factors.
A retrospective analysis of the MarketScan® Databases identified patients with SCS implant (2009-2014) and continuous health plan enrollment for ≥12-months (12 m) preimplant. For logistic regression analysis, patients were enrolled for 12 m postimplant. Kaplan-Meier and Cox Proportional Hazard survival analyses assessed time to infection, with infection rate reported at 12 m postimplant. Logistic regression characterized risk factors based on demographics, comorbidities, and clinical characteristics.
In the logistic regression (n = 6615), 12 m device-related infection rate was 3.11%. Infection risk factors included peripheral vascular disease (OR, 1.784; 95% CI: 1.011-3.149; p = 0.0457) and infection in 12 m before implant (OR, 1.518; 95% CI: 1.022-2.254; p = 0.0386). The odds of patients experiencing an infection decreased by 3.2% with each additional year of age (OR, 0.968; 95% CI: 0.952-0.984; p < 0.0001). Survival analysis (n = 13,214) identified prior infection (HR, 1.770; 95% CI: 1.342-2.336; p < 0.0001) as a risk factor. Infection was less likely in older patients (HR, 0.974; 95% CI: 0.962-0.986; p < 0.0001). Expected risk factors including obesity, diabetes, and smoking were not identified as risk factors in this analysis. There was no significant difference between infection rate for initial and replacement implants.
The 3.11% SCS-related infection rate within 12 m of implant emphasizes the need for improved infection control practices. Research is needed to limit SCS infections in younger patients and those with infection history.
手术部位感染会导致不良的临床和经济后果。最近一项关于脊髓刺激（SCS）感染控制实践的国际调查显示，对循证指南的依从性较低。本研究确定了SCS植入物的感染率，并识别了感染风险因素。
对MarketScan®数据库进行回顾性分析，确定接受SCS植入的患者（2009 - 2014年），且在植入前连续参加健康计划≥12个月（12 m）。对于逻辑回归分析，患者在植入后纳入12 m。Kaplan-Meier和Cox比例风险生存分析评估感染时间，报告植入后12 m的感染率。逻辑回归根据人口统计学、合并症和临床特征对风险因素进行特征描述。
在逻辑回归分析中（n = 6615），植入后12 m与设备相关的感染率为3.11%。感染风险因素包括外周血管疾病（OR，1.784；95% CI：1.011 - 3.149；p = 0.0457）和植入前12 m内有感染（OR，1.518；95% CI：1.022 - 2.254；p = 0.0386）。患者年龄每增加一岁，发生感染的几率降低3.2%（OR，0.968；95% CI：0.952 - 0.984；p < 0.0001）。生存分析（n = 13,214）确定既往感染（HR，1.770；95% CI：1.342 - 2.336；p < 0.0001）为风险因素。老年患者感染的可能性较小（HR，0.974；95% CI：0.962 - 0.986；p < 0.0001）。本分析未将肥胖、糖尿病和吸烟等预期风险因素识别为风险因素。初次植入和更换植入物的感染率之间无显著差异。
植入后12 m内SCS相关感染率为3.11%，强调需要改进感染控制措施。需要开展研究以减少年轻患者和有感染史患者的SCS感染。
