Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Knee Surg Sports Traumatol Arthrosc. 2021 Feb;29(2):429-436. doi: 10.1007/s00167-020-05943-4. Epub 2020 Apr 1.
Although several small-scale studies have reported risk factors for surgical site infection (SSI) after high tibial osteotomy (HTO), no study has collectively analysed risk factors in a large cohort. The present study aimed to clarify the risk factors for SSI after HTO using a national database.
Data of inpatients who underwent HTO from 2010 to 2017 were obtained from the Diagnosis Procedure Combination database in Japan. Outcome measures were the incidence of SSI and deep SSI after HTO. Associations between SSI and patient data were examined with multivariable logistic regression analysis.
Among 12,853 patients who underwent HTO, 195 developed SSI (1.52%) and 50 developed deep SSI (0.39%). Univariate analysis showed that male sex, smoking, and longer anaesthesia duration were associated with higher incidences of SSI, whereas a primary diagnosis of osteonecrosis and use of natural bone grafts were associated with lower incidences. In multivariable analysis, SSI was positively associated with male sex, anaesthesia duration longer than 210 min (vs. 150-210 min), and use of artificial bone graft (vs. natural bone graft). SSI was negatively associated with age ≤ 49 years (vs. 50-59 years) and a primary diagnosis of osteonecrosis (vs. osteoarthritis).
The present study revealed novel risk factors for SSI after HTO that previous studies have failed to find, including use of artificial bone graft and longer anaesthesia duration; primary diagnosis of osteonecrosis and younger age were novel protective factors. These findings will help surgeons assess risks of SSI after HTO in individual patients.
III.
尽管一些小规模研究已经报道了胫骨高位截骨术（HTO）后手术部位感染（SSI）的风险因素，但尚无研究在大样本中综合分析这些风险因素。本研究旨在使用国家数据库阐明 HTO 后 SSI 的风险因素。
从日本诊断程序组合数据库中获取 2010 年至 2017 年间接受 HTO 的住院患者数据。结局指标为 HTO 后 SSI 和深部 SSI 的发生率。使用多变量逻辑回归分析检查 SSI 与患者数据之间的关联。
在 12853 例接受 HTO 的患者中，195 例发生 SSI（1.52%），50 例发生深部 SSI（0.39%）。单因素分析显示，男性、吸烟和较长的麻醉持续时间与 SSI 发生率较高相关，而原发性骨坏死和使用天然骨移植物与较低的发生率相关。多变量分析显示，SSI 与男性、麻醉持续时间超过 210 分钟（与 150-210 分钟相比）和使用人工骨移植物（与天然骨移植物相比）呈正相关。SSI 与年龄≤49 岁（与 50-59 岁相比）和原发性骨坏死（与骨关节炎相比）呈负相关。
本研究揭示了 HTO 后 SSI 的新的风险因素，包括使用人工骨移植物和较长的麻醉持续时间，以前的研究未能发现这些因素；原发性骨坏死和年轻的年龄是新的保护因素。这些发现将有助于外科医生评估个体患者 HTO 后 SSI 的风险。
III。
