减少脊柱肿瘤手术中的手术部位感染：三种方法的比较。
Reducing Surgical Site Infections in Spine Tumor Surgery: A Comparison of Three Methods.
机构信息
Department of Orthopedics & Rehabilitation, University of Rochester School of Medicine, Rochester, NY.
出版信息
Spine (Phila Pa 1976). 2019 Dec 15;44(24):E1428-E1435. doi: 10.1097/BRS.0000000000003177.
STUDY DESIGN
Case control series.
OBJECTIVE
The aim of this study was to evaluate and compare the effectiveness of methods to decrease surgical site infections (SSIs) following spine tumor surgery.
SUMMARY OF BACKGROUND DATA
With the aging population of the United States, the prevalence of cancer and associated metastatic spine disease is increasing. The most common complication of spine tumor surgery is SSI.
METHODS
This a single-institution case-control series of patients undergoing spine tumor surgery from June 2003 to October 2018. Patients were grouped into the following groups: Betadine irrigation and intrawound vancomycin powder (BIVP), intrawound vancomycin powder only (IVP), and patients receiving neither (NONE). The primary outcome was SSIs/wound complications.
RESULTS
One hundred fifty-one spine tumor patients undergoing 174 procedures meeting our inclusion criteria were identified. The BIVP group had 60 patients (73 procedures); the IVP group had 46 patients (47 procedures); and the NONE group had 45 patients (54 procedures). The overall infection rate was 8.6% of all procedures (15/174) and 9.9% (15/151) of all patients. Bivariate analysis comparing patients with and without infections noted the patients with SSIs had significantly higher rates of preoperative radiation treatment (53.3% in infection group vs. 25.5% in noninfection group), P = 0.02. Patients undergoing procedures in the BIVP group had a significantly lower rate of infections (2.7%) than the patients in the IVP (12.8%) and NONE (13%) groups, P = 0.04. Stepwise regression analysis was used to evaluate further factors associated with SSIs. Elevated BMI was significantly associated with SSIs in the model [P = 0.02, odds ratio (OR) 1.14]. BIVP was also protective against infections as compared to the IVP and NONE groups, P = 0.02, OR 0.02.
CONCLUSION
BIVP led to a significant decrease in SSI rates following spine tumor surgery. Administration of BIVP is not time consuming and decreased SSI rates.
LEVEL OF EVIDENCE
研究设计
病例对照系列。
目的
本研究旨在评估和比较减少脊柱肿瘤手术后手术部位感染（SSI）的方法的有效性。
背景数据概要
随着美国人口老龄化，癌症和相关转移性脊柱疾病的患病率正在增加。脊柱肿瘤手术后最常见的并发症是 SSI。
方法
这是一项来自 2003 年 6 月至 2018 年 10 月的单机构病例对照系列研究，对接受脊柱肿瘤手术的患者进行分组：洗必泰冲洗和切口内万古霉素粉（BIVP）、仅切口内万古霉素粉（IVP）和未接受任何治疗的患者（NONE）。主要结果是 SSI/伤口并发症。
结果
确定了符合纳入标准的 151 名脊柱肿瘤患者，共进行了 174 次手术。BIVP 组有 60 名患者（73 例手术）；IVP 组有 46 名患者（47 例手术）；NONE 组有 45 名患者（54 例手术）。所有手术的总体感染率为 8.6%（15/174），所有患者的感染率为 9.9%（15/151）。比较有感染和无感染患者的双变量分析表明，有 SSI 的患者术前接受放射治疗的比例明显较高（感染组为 53.3%，非感染组为 25.5%），P=0.02。BIVP 组的感染率明显低于 IVP（12.8%）和 NONE（13%）组（2.7%），P=0.04。采用逐步回归分析进一步评估与 SSI 相关的因素。升高的 BMI 在模型中与 SSI 显著相关（P=0.02，优势比[OR]1.14）。与 IVP 和 NONE 组相比，BIVP 也能预防感染，P=0.02，OR 0.02。
结论
BIVP 显著降低了脊柱肿瘤手术后 SSI 的发生率。BIVP 的使用并不耗时，并且降低了 SSI 的发生率。
证据水平
3 级。
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