Nie James, Torabi Sina, Hsia Henry C
From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Ann Plast Surg. 2021 Mar 1;86(3S Suppl 2):S342-S347. doi: 10.1097/SAP.0000000000002685.
Despite limited evidence, a common belief in surgical practice is that patients should not undergo elective surgery until any open wounds heal because of the risk of seeding infection to the new surgical site. To our knowledge, this is the first study to analyze postoperative complication rates for implants placed in the context of open wounds using the American College of Surgeons National Surgical Quality Improvement Program database. We examined 30-day postoperative infections for breast, hip, knee, and spine implants using the 2012-2016 American College of Surgeons National Surgical Quality Improvement Program database. Patients were excluded for missing data and propensity matched 1:10 for demographics and comorbidities to minimize confounders. Complication rates were assessed using Pearson χ2 tests. Of 475,101 patients who received breast, hip, knee, or spine implants, 1491 did so with an open wound. After propensity score matching, the overall complication rate remained higher with the open wound cohort (6.7% vs 3.8%, P < 0.001). Although the presence of an open wound was associated with an increased risk of superficial surgical site infection, it was not associated with an increased risk of organ space surgical site infection, the site best correlated with infection at the implant. Nor was the presence of an open wound associated with a statistically significantly increased risk of deep incisional surgical site infection or wound dehiscence. After controlling for demographics, preoperative comorbidities, and surgical factors, the presence of an open wound before implant surgery is associated with an increased risk of complications, readmission, and reoperation, but not necessarily infection at the surgical site.
尽管证据有限，但外科手术实践中的一个普遍观念是，由于存在将感染播散至新手术部位的风险，患者在任何开放性伤口愈合之前不应接受择期手术。据我们所知，这是第一项利用美国外科医师学会国家外科质量改进计划数据库分析在开放性伤口情况下植入物术后并发症发生率的研究。我们使用2012 - 2016年美国外科医师学会国家外科质量改进计划数据库，对乳房、髋关节、膝关节和脊柱植入物的术后30天感染情况进行了研究。因数据缺失而排除患者，并按1:10的比例对人口统计学和合并症进行倾向匹配，以尽量减少混杂因素。使用Pearson χ2检验评估并发症发生率。在接受乳房、髋关节、膝关节或脊柱植入物的475101例患者中，有1491例是在有开放性伤口的情况下进行植入的。经过倾向评分匹配后，开放性伤口队列的总体并发症发生率仍然较高（6.7%对3.8%，P < 0.001）。虽然存在开放性伤口与浅表手术部位感染风险增加相关，但与器官间隙手术部位感染风险增加无关，而器官间隙手术部位感染是与植入物感染相关性最强的部位。开放性伤口的存在也与深部切口手术部位感染或伤口裂开的风险在统计学上无显著增加无关。在控制了人口统计学、术前合并症和手术因素后，植入手术前存在开放性伤口与并发症、再次入院和再次手术的风险增加相关，但不一定与手术部位感染相关。
