Present address: Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China.
Present address: Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
J Orthop Surg Res. 2021 Feb 15;16(1):137. doi: 10.1186/s13018-021-02276-x.
Periprosthetic infection is a major cause of failure after segmental endoprosthetic reconstruction. The purpose of this study is to determine whether certain aspects of drain output affect infection risk, particularly the 30 mL/day criterion for removal.
Two hundred and ninety-five patients underwent segmental bone resection and lower limb endoprosthetic reconstruction at one institution. Data on surgical drain management and occurrence of infection were obtained from a retrospective review of patients' charts and radiographs. Univariate and multivariate Cox regression analyses were performed to identify factors associated with infection.
Thirty-one of 295 patients (10.5%) developed infection at a median time of 13 months (range 1-108 months). Staphylococcus aureus was the most common organism and was responsible for the majority of cases developing within 1 year of surgery. Mean output at the time of drain removal was 72 mL/day. Ten of 88 patients (11.3%) with ≤ 30 mL/day drainage and 21 of 207 patients (10.1%) with > 30 mL/day drainage developed infection (p = 0.84). In multivariate analysis, independent predictive factors for infection included sarcoma diagnosis (HR 4.13, 95% CI 1.4-12.2, p = 0.01) and preoperative chemotherapy (HR 3.29, 95% CI 1.1-9.6, p = 0.03).
Waiting until drain output is < 30 mL/day before drain removal is not associated with decreased risk of infection for segmental endoprostheses of the lower limb after tumor resection. Sarcoma diagnosis and preoperative chemotherapy were independent predictors of infection.
假体周围感染是节段性假体重建后失败的主要原因。本研究旨在确定引流物排出量的某些方面是否会影响感染风险，特别是 30ml/天的引流物排出量标准。
在一个机构中，有 295 例患者接受了节段性骨切除和下肢假体重建。通过回顾患者病历和 X 光片，获得了手术引流管理和感染发生的数据。采用单变量和多变量 Cox 回归分析来确定与感染相关的因素。
295 例患者中有 31 例（10.5%）在中位时间 13 个月（1-108 个月）时发生感染。金黄色葡萄球菌是最常见的病原体，大多数病例发生在手术后 1 年内。引流管拔除时的平均排出量为 72ml/天。88 例引流量≤30ml/天的患者中有 10 例（11.3%）发生感染，207 例引流量>30ml/天的患者中有 21 例（10.1%）发生感染（p=0.84）。多变量分析显示，感染的独立预测因素包括肉瘤诊断（HR 4.13，95%CI 1.4-12.2，p=0.01）和术前化疗（HR 3.29，95%CI 1.1-9.6，p=0.03）。
在肿瘤切除后下肢节段性假体重建中，等待引流物排出量<30ml/天再拔除引流管并不会降低感染风险。肉瘤诊断和术前化疗是感染的独立预测因素。
