Onyekwelu Ikemefuna, Yakkanti Ramakanth, Protzer Lauren, Pinkston Christina M, Tucker Cody, Seligson David
Department of Orthopaedic Surgery (Dr. Onyekwelu, Mr. Tucker, and Dr. Seligson), the School of Medicine (Dr. Yakkanti, Ms. Protzer, and Dr. Seligson), and the Department of Bioinformatics and Biostatistics (Ms. Pinkston), University of Louisville, Louisville, KY.
J Am Acad Orthop Surg Glob Res Rev. 2017 Jun 13;1(3):e022. doi: 10.5435/JAAOSGlobal-D-17-00022. eCollection 2017 Jun.
The Centers for Disease Control and Prevention created a surgical wound classification system (SWC: I, clean; II, clean/contaminated; III, contaminated; and IV, dirty) to preemptively identify patients at risk of surgical site infection (SSI). The validity of this system is yet to be demonstrated in orthopaedic surgery. We hypothesize a poor association between the SWC and the rate of subsequent SSI in orthopaedic trauma cases.
Nine hundred fifty-six orthopaedic cases were reviewed. Wounds were risk stratified intraoperatively using the SWC grades (I-IV). SSI was diagnosed clinically or with objective markers. The SWC was compared with SSI rates using a Fisher exact test. Significance was set at < 0.05.
Four hundred patients met the selection criteria. The rate of infection was not significantly different across the SWC grades ( = 0.270). There was a significantly higher risk of SSI among patients with diabetes ( = 0.028).
The Centers for Disease Control and Prevention SWC showed poor utility in predicting and risk stratifying postoperative SSIs in orthopaedic surgical cases.
美国疾病控制与预防中心创建了一个手术伤口分类系统（SWC：I级，清洁；II级，清洁-污染；III级，污染；IV级，脏污），以预先识别有手术部位感染（SSI）风险的患者。该系统在骨科手术中的有效性尚未得到证实。我们假设在骨科创伤病例中，SWC与后续SSI发生率之间的关联较差。
回顾了956例骨科病例。术中使用SWC分级（I-IV级）对伤口进行风险分层。通过临床诊断或客观指标诊断SSI。使用Fisher精确检验比较SWC与SSI发生率。显著性设定为<0.05。
400名患者符合入选标准。SWC各分级之间的感染率无显著差异（=0.270）。糖尿病患者发生SSI的风险显著更高（=0.028）。
美国疾病控制与预防中心的SWC在预测和对骨科手术病例术后SSI进行风险分层方面效用较差。
