Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.
Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China.
Spine (Phila Pa 1976). 2020 Feb 1;45(3):208-216. doi: 10.1097/BRS.0000000000003218.
A systematic review and meta-analysis.
The objective of this study was to investigate the incidence of surgical site infection (SSI) in patients following spine surgery and the rate of microorganisms in these cases.
Many studies have investigated the incidence and risk factors of SSI following spinal surgery, whereas no meta-analysis studies have been conducted regarding the comprehensive epidemiological incidence of SSI after spine surgery.
We searched the PubMed, Embase, and Cochrane Library databases for relevant studies that reported the incidence of SSI after spine surgery, and manually screened reference lists for additional studies. Relevant incidence estimates were calculated. Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed.
Our meta-analysis included 27 studies, with 603 SSI cases in 22,475 patients. The pooled SSI incidence was 3.1%. Subgroup analysis revealed that the incidence of superficial SSI was 1.4% and the incidence of deep SSI was 1.7%. Highest incidence (13.0%) was found in patients with neuromuscular scoliosis among the different indications. The incidences of SSI in cervical, thoracic, and lumbar spine were 3.4%, 3.7%, and 2.7%, respectively. Compared with posterior approach surgery (5.0%), anterior approach showed a lower incidence (2.3%) of SSI. Instrumented surgery had a higher incidence of SSI than noninstrumented surgery (4.4% vs. 1.4%). Patients with minimally invasive surgery (1.5%) had a lower SSI incidence than open surgery (3.8%). Lower incidence of SSI was found when vancomycin powder was applied locally during the surgery (1.9%) compared with those not used (4.8%). In addition, the rates of Staphylococcus aureus, Staphylococcus epidermidis, and methicillin-resistant Staphylococci in microbiological culture results were 37.9%, 22.7%, and 23.1%, respectively.
The pooled incidence of SSI following spine surgery was 3.1%. These figures may be useful in the estimation of the probability of SSI following spine surgery.
系统评价和荟萃分析。
本研究旨在调查脊柱手术后患者的手术部位感染（SSI）发生率以及此类情况下微生物的种类。
许多研究已经调查了脊柱手术后 SSI 的发生率和危险因素，但尚无荟萃分析研究涉及脊柱手术后 SSI 的综合流行病学发生率。
我们检索了 PubMed、Embase 和 Cochrane 图书馆数据库中有关脊柱手术后 SSI 发生率的研究，并手动筛选了参考文献列表以获取其他研究。计算了相关的发生率估计值。还进行了亚组分析、敏感性分析和发表偏倚评估。
我们的荟萃分析纳入了 27 项研究，涉及 22475 名患者的 603 例 SSI 病例。总体 SSI 发生率为 3.1%。亚组分析显示，浅表 SSI 的发生率为 1.4%，深部 SSI 的发生率为 1.7%。不同适应证中，神经肌肉性脊柱侧凸患者的发生率最高（13.0%）。颈椎、胸椎和腰椎的 SSI 发生率分别为 3.4%、3.7%和 2.7%。与后路手术（5.0%）相比，前路手术的 SSI 发生率较低（2.3%）。器械辅助手术的 SSI 发生率高于非器械辅助手术（4.4%比 1.4%）。微创手术（1.5%）的 SSI 发生率低于开放手术（3.8%）。术中局部应用万古霉素粉（1.9%）比不使用（4.8%）时，SSI 的发生率较低。此外，微生物培养结果中金黄色葡萄球菌、表皮葡萄球菌和耐甲氧西林金黄色葡萄球菌的检出率分别为 37.9%、22.7%和 23.1%。
脊柱手术后 SSI 的总体发生率为 3.1%。这些数据可能有助于估计脊柱手术后 SSI 的概率。
3 级。
