Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
BMC Musculoskelet Disord. 2020 Dec 18;21(1):845. doi: 10.1186/s12891-020-03822-0.
Surgical site infections (SSI) after distal radius fracture (DRF) surgery have not previously been studied as the primary outcome in a large population with comparative data for different surgical methods. The aims of this study were 1) to compare SSI rates between plate fixation, percutaneous pinning and external fixation, and 2) to study factors associated with SSI.
We performed a nation-wide cohort study linking data from the Swedish national patient register (NPR) with the Swedish prescribed drug register (SPDR). We included all patients ≥18 years with a registration of a surgically treated DRF in the NPR between 2006 and 2013. The primary outcome was a registration in the SPDR of a dispensed prescription of peroral Flucloxacillin and/or Clindamycin within the first 8 weeks following surgery, which was used as a proxy for an SSI. The SSI rates for the three main surgical methods were calculated. Logistic regression was used to study the association between surgical method and the primary outcome, adjusted for potential confounders including age, sex, fracture type (closed/open), and a dispensed prescription of Flucloxacillin and/or Clindamycin 0-8 weeks prior to DRF surgery. A classification tree analysis was performed to study which factors were associated with SSI.
A total of 31,807 patients with a surgically treated DRF were included. The proportion of patients with an SSI was 5% (n = 1110/21,348) among patients treated with plate fixation, 12% (n = 754/6198) among patients treated with percutaneous pinning, and 28% (n = 1180/4261) among patients treated with external fixation. After adjustment for potential confounders, the surgical method most strongly associated with SSI was external fixation (aOR 6.9 (95% CI 6.2-7.5, p < 0.001)), followed by percutaneous pinning (aOR 2.7 (95% CI 2.4-3.0, p < 0.001)) (reference: plate fixation). The classification tree analysis showed that surgical method, fracture type (closed/open), age and sex were factors associated with SSI.
The SSI rate was highest after external fixation and lowest after plate fixation. The results may be useful for estimation of SSI burdens after DRF surgery on a population basis. For the physician, they may be useful for estimating the likelihood of SSI in individual patients.
此前，在一个具有不同手术方法的比较数据的大人群中，并未将外科部位感染（SSI）作为桡骨远端骨折（DRF）手术后的主要结果进行研究。本研究的目的是 1）比较钢板固定、经皮穿针固定和外固定的 SSI 发生率，2）研究与 SSI 相关的因素。
我们进行了一项全国性队列研究，将来自瑞典全国患者登记处（NPR）的数据与瑞典处方药物登记处（SPDR）的数据相链接。我们纳入了 2006 年至 2013 年间 NPR 中接受手术治疗的 DRF 登记的所有年龄≥18 岁的患者。主要结果是在手术后 8 周内 SPDR 中记录的口服氟氯西林和/或克林霉素的处方配药，这被用作 SSI 的替代指标。计算了三种主要手术方法的 SSI 发生率。使用逻辑回归来研究手术方法与主要结果之间的关联，调整了包括年龄、性别、骨折类型（闭合/开放）和 DRF 手术前 0-8 周内氟氯西林和/或克林霉素的处方配药在内的潜在混杂因素。进行分类树分析以研究与 SSI 相关的因素。
共纳入了 31807 例接受手术治疗的 DRF 患者。钢板固定组患者的 SSI 发生率为 5%（n=1110/21348），经皮穿针固定组为 12%（n=754/6198），外固定组为 28%（n=1180/4261）。调整潜在混杂因素后，与 SSI 最密切相关的手术方法是外固定（OR 6.9（95%CI 6.2-7.5，p<0.001）），其次是经皮穿针固定（OR 2.7（95%CI 2.4-3.0，p<0.001））（参考：钢板固定）。分类树分析表明，手术方法、骨折类型（闭合/开放）、年龄和性别是与 SSI 相关的因素。
外固定后的 SSI 发生率最高，钢板固定后最低。结果可能有助于基于人群估计 DRF 手术后 SSI 的负担。对于医生，这些结果可能有助于估计个别患者发生 SSI 的可能性。
