青霉素过敏与开放式腹壁疝修补术后结局的关系。
The association of penicillin allergy with outcomes after open ventral hernia repair.
机构信息
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA.
Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
出版信息
Surg Endosc. 2020 Sep;34(9):4148-4156. doi: 10.1007/s00464-019-07183-1. Epub 2020 Feb 3.
BACKGROUND
Up to 11% of patients report a penicillin allergy (PA), with 1-2% demonstrating a true IgE mediated allergy upon testing. PA patients often receive non-beta-lactam antibiotic surgical prophylaxis (non-BLP). This study evaluates the relationship of PA to outcomes after open ventral hernia repair (OVHR).
METHODS
A prospective institutional database was queried for patients undergoing OVHR. Demographics, operative characteristics, and outcomes were evaluated by the reported PA and the administration of beta-lactam prophylaxis (BLP).
RESULTS
Allergy histories were reviewed in 1178 patients. PA was reported in 21.6% of patients, with 55.5% reporting rash or hives, 15.0% airway compromise or anaphylaxis, and 29.5% no specific reaction. BLP was administered to 76.3% of patients, including 22.1% of PA patients and 89.9% of patients without PA. PA patients were more often female (64.6% PA patients vs. 56% non-PA, p = 0.01), with higher rates of chronic steroids, MRSA, anxiety, asthma, COPD, chronic pain, and sleep apnea (p < 0.03 all values). PA patients had higher rates of contaminated cases, including mesh infection and fistula. Of the 683 clean cases, 82.1% received BLP. Of the 117 clean contaminated cases (CDC wound class 2), 82.9% received BLP, which was associated with reduced long-term readmission for hernia complications (21.5 vs. 55%, p = 0.002, OR 0.27, CI 0.09-0.83). In the 120 CDC wound class 3 and 4 patients, 65.8% received BLP. In multivariate analysis, BLP was associated with lower rates of reoperation (OR 0.31, CI 0.12-0.76) and recurrence (OR 0.32, CI 0.11-0.86). BLP was given to 22.1% of the PA patients with no adverse reactions noted.
CONCLUSION
PA patients had more comorbidities and complex ventral hernias. When controlling for contamination and MRSA history, BLP is associated with improved outcomes particularly in contaminated cases. PA may be a risk factor for patient complexity, and further studies are warranted to determine if allergy testing can be warranted in known or anticipated contaminated cases.
背景
多达 11%的患者报告有青霉素过敏（PA），其中 1-2%在检测时表现出真正的 IgE 介导的过敏。PA 患者经常接受非β-内酰胺抗生素手术预防（非 BLP）。本研究评估了 PA 与开放式腹疝修复（OVHR）后结局的关系。
方法
前瞻性机构数据库中检索了接受 OVHR 的患者。通过报告的 PA 和β-内酰胺预防（BLP）的管理，评估了人口统计学、手术特征和结局。
结果
对 1178 例患者的过敏史进行了回顾。21.6%的患者报告有 PA，其中 55.5%报告有皮疹或荨麻疹，15.0%有气道阻塞或过敏反应，29.5%无特定反应。76.3%的患者接受了 BLP，包括 22.1%的 PA 患者和 89.9%的无 PA 患者。PA 患者更常见于女性（64.6%的 PA 患者 vs. 56%的非 PA 患者，p=0.01），并且更常患有慢性类固醇、MRSA、焦虑、哮喘、COPD、慢性疼痛和睡眠呼吸暂停（所有值均<0.03）。PA 患者有更高的污染病例发生率，包括网片感染和瘘管。在 683 例清洁病例中，82.1%接受了 BLP。在 117 例清洁污染病例（CDC 伤口分类 2）中，82.9%接受了 BLP，这与疝并发症的长期再入院率降低有关（21.5% vs. 55%，p=0.002，OR 0.27，CI 0.09-0.83）。在 120 例 CDC 伤口分类 3 和 4 患者中，65.8%接受了 BLP。在多变量分析中，BLP 与较低的再手术率（OR 0.31，CI 0.12-0.76）和复发率（OR 0.32，CI 0.11-0.86）相关。在没有不良反应的情况下，BLP 被给予 22.1%的 PA 患者。
结论
PA 患者有更多的合并症和复杂的腹疝。在控制污染和 MRSA 病史的情况下，BLP 与改善结局相关，尤其是在污染病例中。PA 可能是患者复杂性的一个危险因素，有必要进一步研究确定在已知或预期污染病例中是否需要进行过敏测试。
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