低蛋白血症增加了脊柱手术后治疗术后急性手术部位感染的住院时间。
Hypoalbuminemia Increased the Length of Stay in the Treatment of Postoperative Acute Surgical Site Infection in Spinal Surgery.
机构信息
Department of Orthopedic Surgery, Nara Medical University, Kashihara.
Department of Orthopaedic Surgery, Nara City Hospital, Nara.
出版信息
Spine (Phila Pa 1976). 2020 Dec 1;45(23):E1564-E1571. doi: 10.1097/BRS.0000000000003684.
STUDY DESIGN
Multicenter retrospective study.
OBJECTIVE
The aim of this study was to identify specific risk factors for increased length of stay (LOS) in the management of acute surgical site infection (SSI) following spinal surgery.
SUMMARY OF BACKGROUND DATA
Postoperative SSI is a serious complication of spinal surgery and is known to be associated with increased LOS and additional cost. Although many risk factors contribute to the development of SSI following spinal surgery, little is known about risk factors associated with the treatment of SSI that contribute to increased LOS.
METHODS
Patients at two institutions experiencing deep SSI following spinal surgery between January 2009 and December 2016 were identified. The patients were divided into two groups depending upon the median LOS attributable to SSI. The effects of patient characteristics, comorbidities, disease history, and invasiveness of the elective surgery on the risk of increased LOS were determined using univariate analyses and multivariate logistic regression.
RESULTS
Of the 1656 spinal surgery cases, 40 (2.4%) experienced deep SSI. The median LOS was 67 days. Multivariate logistic regression analysis revealed that hypoalbuminemia during hospitalization was associated with increased LOS (odds ratio 0.042, confidence interval 0.005-0.342; P = 0.003). We determined the appropriate diagnostic cutoff of hypoalbuminemia during hospitalization using receiver-operating characteristic curves. A serum albumin level <3.1 g/dL (sensitivity, 86.4%; specificity, 75.0%; area under the curve, 0.84) was indicative of a longer hospital stay.
CONCLUSION
Low serum albumin level during hospitalization was an independent risk factor for increased LOS in the treatment of SSI following spinal surgery. When the serum albumin level is <3.1 g/dL in patients with SSI, we should consider interventions aimed at correcting this hypoalbuminemia.
LEVEL OF EVIDENCE
研究设计
多中心回顾性研究。
目的
本研究旨在确定导致脊柱手术后急性手术部位感染（SSI）管理中住院时间延长（LOS）的特定危险因素。
背景资料总结
术后 SSI 是脊柱手术后的一种严重并发症，已知与 LOS 延长和额外费用增加有关。尽管许多危险因素导致脊柱手术后发生 SSI，但对于与 SSI 治疗相关导致 LOS 延长的危险因素知之甚少。
方法
确定 2009 年 1 月至 2016 年 12 月期间在两个机构因脊柱手术后发生深部 SSI 的患者。根据 SSI 导致的 LOS 中位数，将患者分为两组。使用单变量分析和多变量逻辑回归确定患者特征、合并症、病史和择期手术的侵袭性对 LOS 风险增加的影响。
结果
在 1656 例脊柱手术病例中，有 40 例（2.4%）发生深部 SSI。中位 LOS 为 67 天。多变量逻辑回归分析显示，住院期间低白蛋白血症与 LOS 延长相关（比值比 0.042，置信区间 0.005-0.342；P=0.003）。我们使用受试者工作特征曲线确定了住院期间低白蛋白血症的适当诊断临界值。血清白蛋白水平 <3.1g/dL（敏感性，86.4%；特异性，75.0%；曲线下面积，0.84）提示住院时间延长。
结论
住院期间低血清白蛋白水平是脊柱手术后 SSI 治疗中 LOS 延长的独立危险因素。当 SSI 患者的血清白蛋白水平 <3.1g/dL 时，我们应考虑采取干预措施纠正这种低白蛋白血症。
证据水平
4 级。
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