From the Department of Anesthesiology, University of Utah, Salt Lake City, Utah.
Huntsman Cancer Institute, Salt Lake City, Utah.
Anesth Analg. 2020 Jul;131(1):280-287. doi: 10.1213/ANE.0000000000004639.
The efficacy of intrathecal drug delivery (IDD) for cancer-related pain is well established. Cancer therapies are often associated with immunosuppression and increased risk of infection, and the rate of infection after intrathecal drug delivery system (IDDS) implant in cancer patients has been reported as 2.4%-6.3%. Our objective is to report on the rate of surgical site infections (SSI) in patients implanted with IDDS for cancer-related pain and to provide a data-driven discussion on the relationship between antineoplastic treatment, leukopenia, and other clinical or demographic characteristics and SSI.
Following local institutional review board approval, we conducted a retrospective chart review of IDDS implants from May 2014 through December 2018. Data collected included demographic data, health status, prophylactic antibiotic administration, surgery duration, presence of leukopenia (white blood cell [WBC] count of <4.0 K/µL) or moderate neutropenia (absolute neutrophil count [ANC] of <1000/μL) within the 30 days before IDDS implant, and details of antineoplastic treatment or systemic corticosteroid use in the perioperative period. This information was assessed in relation to SSI incidence up to 6 months following implant.
Two hundred seventeen IDDS implants were identified. A majority of patients (79.3%) received ≥1 form of antineoplastic therapy within 30 days before or after implant, and 42.4% received multiple forms of antineoplastic therapy. Therapies included chemotherapy in 46.5%, immunotherapy in 28.6%, systemic steroids in 32.3%, and radiation therapy in 28.1%. One-quarter of patients (25.8%) were leukopenic within 30 days before implant, with 3.2% having moderate neutropenia. There were 2 infectious complications representing an infection rate of 0.9% (95% CI, 0.1%-3.3%), with limited shared characteristics between those experiencing SSI.
SSI risk after IDDS placement for cancer pain is low, despite frequent concurrent antineoplastic therapy and leukopenia in the perioperative period. Concomitant cancer therapies should not be a barrier to the implementation of IDD for cancer pain.
鞘内药物输注（IDD）治疗癌症相关疼痛的疗效已得到充分证实。癌症治疗通常与免疫抑制和感染风险增加有关，已有报道称癌症患者接受鞘内药物输注系统（IDDS）植入后的感染率为 2.4%-6.3%。我们的目的是报告癌症相关性疼痛患者接受 IDDS 植入后的手术部位感染（SSI）发生率，并提供一个基于数据的讨论，探讨抗肿瘤治疗、白细胞减少症以及其他临床或人口统计学特征与 SSI 之间的关系。
在获得当地机构审查委员会批准后，我们对 2014 年 5 月至 2018 年 12 月期间接受 IDDS 植入的患者进行了回顾性图表审查。收集的数据包括人口统计学数据、健康状况、预防性抗生素使用、手术持续时间、白细胞减少症（白细胞计数<4.0 K/µL）或中度中性粒细胞减少症（绝对中性粒细胞计数<1000/µL）在 IDDS 植入前 30 天内的存在情况，以及围手术期抗肿瘤治疗或全身皮质类固醇使用的详细信息。将这些信息与植入后 6 个月内的 SSI 发生率进行评估。
共确定了 217 例 IDDS 植入病例。大多数患者（79.3%）在植入前后 30 天内接受了≥1 种形式的抗肿瘤治疗，42.4%的患者接受了多种形式的抗肿瘤治疗。治疗包括化疗 46.5%、免疫治疗 28.6%、全身皮质类固醇治疗 32.3%和放射治疗 28.1%。四分之一的患者（25.8%）在植入前 30 天内白细胞减少症，其中 3.2%有中度中性粒细胞减少症。有 2 例感染并发症，感染率为 0.9%（95%CI，0.1%-3.3%），发生 SSI 的患者之间几乎没有共同特征。
尽管围手术期经常同时进行抗肿瘤治疗和白细胞减少症，但癌症疼痛患者接受 IDDS 植入后的 SSI 风险较低。同时进行癌症治疗不应成为实施癌症疼痛 IDD 的障碍。
