Patel S, Thompson D, Innocent S, Narbad V, Selway R, Barkas K
King's College NHS Foundation Trust , UK.
King's College London , UK.
Ann R Coll Surg Engl. 2019 Mar;101(3):220-225. doi: 10.1308/rcsann.2019.0001. Epub 2019 Jan 30.
Surgical site infections (SSIs) are of profound significance in neurosurgical departments, resulting in high morbidity and mortality. There are limited public data regarding the incidence of SSIs in neurosurgery. The aim of this study was to determine the rate of SSIs (particularly those requiring reoperation) over a seven-year period and identify factors leading to an increased risk.
An age matched retrospective analysis was undertaken of a series of 16,513 patients at a single centre. All patients who required reoperation for suspected SSIs within a 7-year period were identified. Exclusion criteria comprised absence of infective material intraoperatively and patients presenting with primary infections. Clinical notes were reviewed to confirm presence or absence of suspected risk factors.
Of the 16,513 patients in the study, 1.20% required at least one further operation to treat a SSI. Wound leak (odds ratio [OR]: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74) and operative duration >180 minutes (OR: 1.85) were statistically significant risk factors for reoperation.
This is the first UK study of such a duration that has documented a SSI reoperation rate in a cohort of this size. Various risk factors are associated with the development of SSIs, making it essential to have robust auditing and monitoring of high risk patients to ensure excellent standards of healthcare. Departmental and public registers to record all SSIs may be beneficial, particularly for those treated solely by general practitioners, allowing units to address potential risk factors prior to surgical intervention.
手术部位感染（SSIs）在神经外科具有重大意义，会导致高发病率和死亡率。关于神经外科手术部位感染发生率的公开数据有限。本研究的目的是确定七年期间手术部位感染（特别是那些需要再次手术的感染）的发生率，并识别导致风险增加的因素。
对单一中心的16513例患者进行年龄匹配的回顾性分析。确定了所有在7年期间因疑似手术部位感染而需要再次手术的患者。排除标准包括术中无感染物质以及患有原发性感染的患者。查阅临床记录以确认是否存在疑似风险因素。
在该研究的16513例患者中，1.20%至少需要进行一次进一步手术来治疗手术部位感染。伤口渗漏（比值比[OR]：27.41）、使用地塞米松（OR：3.55）、器械植入（OR：2.74）和手术持续时间>180分钟（OR：1.85）是再次手术的统计学显著风险因素。
这是英国首次进行如此长时间的研究，记录了如此规模队列中的手术部位感染再次手术率。各种风险因素与手术部位感染的发生相关，因此对高危患者进行有力的审核和监测以确保优质医疗保健标准至关重要。记录所有手术部位感染的科室和公共登记册可能会有所帮助，特别是对于那些仅由全科医生治疗的患者，这可以使各单位在手术干预前解决潜在风险因素。
