Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
World Neurosurg. 2019 Oct;130:e839-e845. doi: 10.1016/j.wneu.2019.06.235. Epub 2019 Jul 9.
Risk factors for infection after vagus nerve stimulation (VNS) device implantation represent an important issue but remain unclear. We hypothesized that specific risk factors for infection would be associated with VNS device implantation. This study reviewed patients with epilepsy who underwent VNS device implantation and undertook a statistical analysis of risk factors for surgical site infection (SSI).
We reviewed all medical records for patients who underwent VNS therapy in our facility between August 2011 and May 2018. Age, sex, height, body weight, body mass index (BMI), intelligence quotient (IQ), surgical incision opening time, blood loss, epilepsy classification, activities of daily living, and generator replacement were statistically compared between cases with and without SSI.
We performed 208 VNS device implantation surgeries at our facility during the study period. Among these, 150 patients underwent initial implantation, 56 patients underwent first generator replacement, and 2 patients underwent second replacement. Six patients (2.7%) with initial implantation and 3 patients (5.4%) with first replacement showed SSI. Low BMI was a risk factor for infection at initial implantation (P < 0.0012) using a BMI within 1.78 kg/m of the cutoff for being underweight (100% sensitivity, 25% specificity). Low IQ (P = 0.0015) was also a risk factor for SSI.
This study identified low BMI and low IQ at initial implantation as risk factors for infection.
迷走神经刺激（VNS）装置植入后感染的危险因素是一个重要问题，但仍不清楚。我们假设与 VNS 装置植入相关的特定感染危险因素。本研究回顾了在我们中心接受 VNS 装置植入的癫痫患者，并对手术部位感染（SSI）的危险因素进行了统计分析。
我们回顾了 2011 年 8 月至 2018 年 5 月期间在我们中心接受 VNS 治疗的所有患者的病历。对 SSI 病例和非 SSI 病例的年龄、性别、身高、体重、体重指数（BMI）、智商（IQ）、手术切口开放时间、失血量、癫痫分类、日常生活活动以及发生器更换进行了统计学比较。
在研究期间，我们在中心进行了 208 例 VNS 装置植入手术。其中，150 例患者进行了初始植入，56 例患者进行了第一次发生器更换，2 例患者进行了第二次更换。6 例（2.7%）初始植入和 3 例（5.4%）首次更换的患者出现 SSI。使用 BMI 低于 1.78kg/m 的消瘦截断值（100%灵敏度，25%特异性），低 BMI 是初始植入感染的危险因素（P < 0.0012）。低 IQ（P=0.0015）也是 SSI 的危险因素。
本研究确定了初始植入时低 BMI 和低 IQ 是感染的危险因素。
