Din A, Foden P, Mathew Mo, Periasamy K
North West Deanery, United Kingdom.
University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
J Orthop. 2019 Aug 14;18:13-15. doi: 10.1016/j.jor.2019.08.026. eCollection 2020 Mar-Apr.
To determine if there is a difference in the rate of early infection in hip fracture surgery performed under laminar flow and conventional turbulent ventilation.
The impact on the rates of early surgical site infection (SSI) in patients who sustained a hip fracture after our trauma theatre was moved from a laminar to a non-laminar flow theatre was assessed. Data was retrospectively collected for six months prior to the merging of the trauma service and six months after. For each operation: age, gender, American Society of Anesthesiologists (ASA) grade, dementia, diabetes, immunosuppressants, anticoagulation, smoking status, duration of surgery, administration of peri-operative antibiotics, surgeon grade, skin closure method, and SSI were extracted from the hospital electronic notes with input from the trust's SSI surveillance team.
259 hip fracture operations were performed during this period. Seven patients were excluded due to incomplete information. There were 95 patients in the laminar flow group and 157 in the non-laminar flow group. There were no SSIs in the laminar flow group and a 3.2% SSI rate (Fishers exact p = 0.16) in the non-laminar flow group. Three were superficial infections and two deep. This difference was not statistically significant. Patient characteristics were included in a Firth logistic regression model which did not show a significant change in the odds ratio.
A higher incidence of early SSI was found when hip fracture surgery was performed under non-laminar flow conditions but this difference was not statistically significant. Larger studies may change this outcome.
确定在层流和传统湍流通气条件下进行的髋部骨折手术中早期感染率是否存在差异。
评估了我们的创伤手术室从层流手术室改为非层流手术室后，髋部骨折患者早期手术部位感染（SSI）发生率的变化。回顾性收集了创伤服务合并前六个月和合并后六个月的数据。对于每台手术：从医院电子病历中提取年龄、性别、美国麻醉医师协会（ASA）分级、痴呆、糖尿病、免疫抑制剂、抗凝、吸烟状况、手术时长、围手术期抗生素使用情况、外科医生级别、皮肤缝合方法和SSI，并由信托基金的SSI监测团队提供相关信息。
在此期间共进行了259例髋部骨折手术。7例患者因信息不完整被排除。层流组有95例患者，非层流组有157例患者。层流组无SSI发生，非层流组SSI发生率为3.2%（Fisher精确检验p = 0.16）。3例为浅表感染，2例为深部感染。这种差异无统计学意义。患者特征纳入Firth逻辑回归模型，该模型未显示优势比有显著变化。
在非层流条件下进行髋部骨折手术时，早期SSI的发生率较高，但这种差异无统计学意义。更大规模的研究可能会改变这一结果。
