Onishi Yuki, Masuda Kazuhiro, Tozawa Keiichiro, Karita Tatsuro
Orthopedic Department, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Clin Spine Surg. 2019 Dec;32(10):E449-E452. doi: 10.1097/BSD.0000000000000908.
This was a retrospective observational study.
The aim of this study was to evaluate the efficacy of our new protocol for preventing postoperative surgical site infection (SSI) following spinal surgery.
SSI following spinal surgery is a serious postoperative complication. Several studies have recently assessed the effectiveness of wound irrigation with povidone-iodine (PVP-I) for SSI prevention, but no consensus has been reached as to how PVP-I should be used in clinical practice. We formed a PVP-I irrigation protocol focusing on the pharmacological properties of PVP-I. This study aimed to evaluate the efficacy and safety of our protocol for preventing SSI.
All cases of spinal surgery at our hospital between October 2011 and September 2016 were retrospectively reviewed. The exclusion criteria were PVP-I allergy, prior surgical debridement for infection, and implant removal surgery. The patients were subdivided into those who had received normal saline irrigation after 90 seconds of 1% PVP-I pooling every 1.5 hours (study group) or only routine saline irrigation every 1.5 hours (control group). The study and control groups comprised of 177 and 146 patients, respectively. This study compared the rate of SSI with and without the use of the PVP-I irrigation protocol.
The SSI rates were 1.7% for the study group (3/177 patients) and 3.4% for the control group (5/146 patients), showing no significant statistical difference (P=0.32). There were no cases of deep SSI in the study group, whereas there were 4 cases in the control group. The deep SSI rate significantly decreased in the study group (P=0.027). No adverse events occurred in the study group.
In this study, 90 seconds of 1% PVP-I pooling every 1.5 hours followed by saline irrigation demonstrated the effectiveness of our protocol for the prevention of postoperative deep SSI after spinal surgery.
这是一项回顾性观察研究。
本研究旨在评估我们新的脊柱手术后预防手术部位感染（SSI）方案的疗效。
脊柱手术后的SSI是一种严重的术后并发症。最近有几项研究评估了聚维酮碘（PVP-I）伤口冲洗预防SSI的有效性，但对于PVP-I在临床实践中的使用方式尚未达成共识。我们基于PVP-I的药理特性制定了PVP-I冲洗方案。本研究旨在评估我们的方案预防SSI的疗效和安全性。
回顾性分析了2011年10月至2016年9月我院所有脊柱手术病例。排除标准为对PVP-I过敏、既往因感染进行手术清创以及植入物取出手术。将患者分为两组，一组每1.5小时用1% PVP-I浸泡90秒后用生理盐水冲洗（研究组），另一组每1.5小时仅进行常规生理盐水冲洗（对照组）。研究组和对照组分别有177例和146例患者。本研究比较了使用和未使用PVP-I冲洗方案时的SSI发生率。
研究组的SSI发生率为1.7%（177例患者中有3例），对照组为3.4%（146例患者中有5例），差异无统计学意义（P = 0.32）。研究组无深部SSI病例，而对照组有4例。研究组的深部SSI发生率显著降低（P = 0.027）。研究组未发生不良事件。
在本研究中，每1.5小时用1% PVP-I浸泡90秒后用生理盐水冲洗，证明了我们的方案对预防脊柱手术后深部SSI的有效性。
