慢性类固醇使用和慢性耐甲氧西林金黄色葡萄球菌感染患者行腰椎融合术后手术部位感染和死亡的风险。
Risk of Surgical Site Infection and Mortality Following Lumbar Fusion Surgery in Patients With Chronic Steroid Usage and Chronic Methicillin-Resistant Staphylococcus aureus Infection.
机构信息
Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA.
Department of Orthopedic Surgery, University of Missouri, Columbia, MO.
出版信息
Spine (Phila Pa 1976). 2019 Apr 1;44(7):E408-E413. doi: 10.1097/BRS.0000000000002864.
STUDY DESIGN
A retrospective database analysis among Medicare beneficiaries OBJECTIVE.: The aim of this study was to determine the effect of chronic steroid use and chronic methicillin-resistant Staphylococcus aureus (MRSA) infection on rates of surgical site infection (SSI) and mortality in patients 65 years of age and older who were treated with lumbar spine fusion.
SUMMARY OF BACKGROUND DATA
Systemic immunosuppression and infection focus elsewhere in the body are considered risk factors for SSI. Chronic steroid use and previous MRSA infection have been associated with an increased risk of SSI in some surgical procedures, but their impact on the risk of infection and mortality after lumbar fusion surgery has not been studied in detail.
METHODS
The PearlDiver insurance-based database (2005-2012) was queried to identify 360,005 patients over 65 years of age who had undergone lumbar spine fusion. Of these patients, those who had been taking oral glucocorticoids chronically and those with a history of chronic MRSA infection were identified. The rates of SSI and mortality in these two cohorts were compared with an age- and risk-factor matched control cohort and odds ratio (OR) was calculated.
RESULTS
Chronic oral steroid use was associated with a significantly increased risk of 1-year mortality [OR = 2.06, 95% confidence interval (95% CI) 1.13-3.78, P = 0.018] and significantly increased risk of SSI at 90 days (OR = 1.74, 95% CI 1.33-1.92, P < 0.001) and 1 year (OR = 1.88, 95% CI 1.41-2.01, P < 0.001). Chronic MRSA infection was associated with a significantly increased risk of SSI at 90 days (OR = 6.99, 95% CI 5.61-9.91, P < 0.001) and 1 year (OR = 24.0, 95%CI 22.20-28.46, P < 0.001) but did not significantly impact mortality.
CONCLUSION
Patients over 65 years of age who are on chronic oral steroids or have a history of chronic MRSA infection are at a significantly increased risk of SSI following lumbar spine fusion.
LEVEL OF EVIDENCE
研究设计
医疗保险受益人群的回顾性数据库分析
目的
本研究旨在确定慢性类固醇使用和慢性耐甲氧西林金黄色葡萄球菌（MRSA）感染对 65 岁及以上接受腰椎融合术患者的手术部位感染（SSI）和死亡率的影响。
背景资料概要
全身性免疫抑制和身体其他部位的感染病灶被认为是 SSI 的危险因素。慢性类固醇使用和先前的 MRSA 感染与某些手术程序中的 SSI 风险增加有关，但它们对腰椎融合术后感染和死亡率风险的影响尚未详细研究。
方法
通过 PearlDiver 保险基础数据库（2005-2012 年）查询，确定了 360,005 名 65 岁以上接受腰椎融合术的患者。在这些患者中，确定了长期口服糖皮质激素治疗的患者和有慢性 MRSA 感染史的患者。将这两个队列的 SSI 和死亡率与年龄和危险因素匹配的对照组进行比较，并计算比值比（OR）。
结果
慢性口服类固醇使用与 1 年死亡率显著增加相关[OR=2.06，95%置信区间（95%CI）为 1.13-3.78，P=0.018]，与 90 天（OR=1.74，95%CI 为 1.33-1.92，P<0.001）和 1 年（OR=1.88，95%CI 为 1.41-2.01，P<0.001）的 SSI 风险显著增加相关。慢性 MRSA 感染与 90 天（OR=6.99，95%CI 为 5.61-9.91，P<0.001）和 1 年（OR=24.0，95%CI 为 22.20-28.46，P<0.001）的 SSI 风险显著增加相关，但对死亡率无显著影响。
结论
65 岁以上接受慢性口服类固醇治疗或有慢性 MRSA 感染史的患者在接受腰椎融合术后发生 SSI 的风险显著增加。
证据水平
3 级
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