Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY.
JBJS Rev. 2020 Mar;8(3):e0163. doi: 10.2106/JBJS.RVW.19.00163.
Considerable variation exists in surgical site infection (SSI) prevention practices for pediatric patients undergoing spinal deformity surgery, but the incidence of SSI has been reported to remain high in the United States. The literature reports various risk factors associated with SSI but findings are inconsistent. The purpose of this systematic review and meta-analysis was to assess the published literature investigating associations between various risk factors and SSI in pediatric patients undergoing spinal surgery.
The systematic review and the meta-analysis were conducted according to Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines among peer-reviewed journals published in English between January 2000 and April 2019. Studies that involved pediatric patients with spinal deformity undergoing surgical procedures in North America and assessed risk factors for SSI were included. The quality of individual studies was assessed, and weighted risk ratios and mean differences were calculated for each risk factor.
Of 763 potential articles identified, 13 met inclusion criteria; 7 studies were rated as average and 6, as poor quality based on the quality checklist. The meta-analysis demonstrated that the SSI risk increased by the following factors: 2.53 (95% confidence interval [CI], 1.26 to 5.10) for overweight to obese patients compared with patients with normal weight, 2.84 (95% CI, 1.67 to 4.81) for patients with a neuromuscular etiology compared with non-neuromuscular etiology, 1.69 (95% CI, 1.41 to 2.02) for patients with a gastrostomy tube (G-tube) compared with those without, 3.45 (95% CI, 2.08 to 5.72) for nonambulatory patients compared with ambulators, and 3.39 (95% CI, 2.38 to 4.83) for patients with pelvic instrumentation compared with those without. Patients who developed SSI also had 158.38 mL (95% CI, 46.78 to 269.97 mL) greater estimated blood loss compared with those who did not.
Despite the limited quality of the available studies and wide variety of populations and outcome definitions, evidence suggests that overweight to obese status, neuromuscular etiology, use of a G-tube, nonambulatory status, instrumentation to the pelvis, and greater estimated blood loss are risk factors for SSI. The use of a common SSI definition and strong methodology are warranted for future studies.
Prognostic Level III. See Instructions for Authors for a complete list of levels of evidence.
小儿脊柱畸形手术患者的手术部位感染（SSI）预防措施存在较大差异，但美国的 SSI 发生率仍居高不下。文献报道了多种与 SSI 相关的危险因素，但结果不一致。本系统评价和荟萃分析的目的是评估已发表的文献，以调查小儿脊柱手术患者各种危险因素与 SSI 之间的关系。
根据 2000 年 1 月至 2019 年 4 月在同行评审期刊上发表的英文文献，按照系统评价和荟萃分析报告规范（PRISMA-P）指南进行系统评价和荟萃分析。纳入了涉及北美接受脊柱手术的小儿脊柱畸形患者并评估 SSI 危险因素的研究。评估了每个研究的质量，并为每个危险因素计算了加权风险比和平均差异。
在 763 篇潜在文章中，有 13 篇符合纳入标准；根据质量检查表，有 7 项研究评为一般质量，6 项研究评为低质量。荟萃分析表明，SSI 风险增加的因素有：与体重正常的患者相比，超重到肥胖的患者为 2.53（95%置信区间[CI]，1.26 至 5.10），与非神经肌肉病因相比，神经肌肉病因的患者为 2.84（95%CI，1.67 至 4.81），与无胃造口管（G-管）相比，有 G-管的患者为 1.69（95%CI，1.41 至 2.02），与非步行患者相比，步行患者为 1.58（95%CI，1.31 至 1.91），与无骨盆器械的患者相比，有骨盆器械的患者为 3.39（95%CI，2.38 至 4.83）。与未发生 SSI 的患者相比，发生 SSI 的患者的估计失血量多 158.38 毫升（95%CI，46.78 至 269.97 毫升）。
尽管现有研究的质量有限，人群和结局定义差异很大，但有证据表明，超重到肥胖状态、神经肌肉病因、使用 G-管、非步行状态、骨盆器械固定以及估计失血量增加是 SSI 的危险因素。未来的研究需要使用通用的 SSI 定义和强大的方法。
预后 III 级。请参阅作者指南，获取完整的证据水平列表。
