Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2019 Oct;130:e846-e853. doi: 10.1016/j.wneu.2019.07.013. Epub 2019 Jul 8.
Surgical site infections (SSIs) complicate 1% to 9% of elective spine surgeries. Previously identified risk factors include diabetes mellitus type 2, obesity, and chronic kidney disease. We sought to determine whether the use of postoperative surgical site drains is associated with deep SSIs.
We retrospectively identified patients operated for deep SSIs after surgery for degenerative spine pathologies between July 2016 and December 2018. Patients were excluded if the reason for operation was other than deep SSI or if their primary operation was for infection or tumor. Using their index procedure and the electronic medical record, patients were matched to controls based on age, surgical invasiveness, International Classification of Diseases, Tenth Revision, Clinical Modification code, race, and sex. Our main outcome of interest was whether drain retention time, total output, or daily output differed significantly between cases and controls.
We identified 38 patients who met inclusion criteria. Infected patients had a higher body mass index (34.2 vs. 29.9 kg/m; P = 0.001), higher odds of having diabetes mellitus type 2 (55.3% vs. 18.4%; P = 0.002), longer drain retention time (5.5 vs. 3.5 days; P = 0.02), and longer inpatient stay (9.5 vs. 4.3 days; P = 0.005). Multivariable logistic regression demonstrated that even after controlling for the other risk factors, drain retention time independently predicted postoperative surgical site infection (odds ratio: 1.36; P = 0.02).
Prolonged surgical drain retention correlates with risk of deep SSI after surgery for degenerative spine disease independent of surgical invasiveness, diabetes mellitus type 2 status, and total drain output. Our data suggest early postoperative drain removal may potentially decrease the risk of SSI and shorten duration of hospital stay.
手术部位感染（SSI）在择期脊柱手术中约占 1%至 9%。先前确定的风险因素包括 2 型糖尿病、肥胖和慢性肾脏病。我们试图确定术后使用手术部位引流是否与深部 SSI 有关。
我们回顾性地确定了 2016 年 7 月至 2018 年 12 月期间因退行性脊柱病变接受深部 SSI 手术后的患者。如果手术的原因不是深部 SSI，或者主要手术是为了感染或肿瘤，则将患者排除在外。使用他们的索引手术和电子病历，根据年龄、手术侵袭性、国际疾病分类、第十版临床修正码、种族和性别，将患者与对照组进行匹配。我们感兴趣的主要结果是病例组和对照组之间的引流保留时间、总输出量或日输出量是否有显著差异。
我们确定了 38 名符合纳入标准的患者。感染患者的体重指数更高（34.2 与 29.9 kg/m；P = 0.001），2 型糖尿病的患病率更高（55.3%与 18.4%；P = 0.002），引流保留时间更长（5.5 与 3.5 天；P = 0.02），住院时间更长（9.5 与 4.3 天；P = 0.005）。多变量逻辑回归表明，即使在控制了其他危险因素后，引流保留时间独立预测术后手术部位感染（比值比：1.36；P = 0.02）。
在退行性脊柱疾病手术后，延长手术引流保留时间与深部 SSI 风险相关，独立于手术侵袭性、2 型糖尿病状态和总引流输出量。我们的数据表明，早期术后引流管移除可能会降低 SSI 的风险并缩短住院时间。
