Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Spine (Phila Pa 1976). 2021 Sep 1;46(17):1147-1153. doi: 10.1097/BRS.0000000000004050.
Retrospective cohort study.
The purpose of this study is to investigate the incidence of surgical site infection in neuromuscular scoliosis (NMS) patients at a tertiary children's hospital before and after the implementation of strategies mentioned in the 2013 Best Practice Guideline.
Patients with NMS are at high risk for surgical site infection following spine surgery. In 2013, a Best Practice Guideline for surgical site infection prevention in high-risk pediatric spine surgery patients reported strategies to decrease incidence. To date, no studies have looked at the efficacy of these strategies.
A retrospective review of surgical site infection in NMS patients was performed. NMS patients undergoing primary posterior spinal fusion from January 2008 to December 2012 (Group 1) and January 2014 to December 2018 (Group 2) were included, with 2013 excluded as a transition year. The primary outcome was incidence of surgical site infection within 1 year of surgery, as defined by the Centers for Disease Control and National Healthcare Safety Network. All patients had at least 1 year of documented follow-up.
One hundred ninety eight patients were included, 62 in Group 1 and 136 in Group 2. Age, BMI, sex, fusion to pelvis, preoperative Cobb angle, incontinence, drain use, blood loss, surgical time, and other perioperative values were similar (P > 0.05). Deep surgical site infection occurred in 10 (16.1%) patients in Group 1 and six (4.4%) patients in Group 2 (P = 0.005). Thirteen (59.1%) identified organisms were gram-negative, with 11 (84.6%) isolated from Group 1 (P = 0.047). Polymicrobial infections accounted for six (37.5%) infections overall.
The incidence of surgical site infection in NMS patients decreased significantly (16.1% vs. 4.4%) after the implementation of the strategies mentioned in the 2013 Best Practice Guideline. Further studies are required to continue to decrease the incidence in this high-risk population.Level of Evidence: 3.
回顾性队列研究。
本研究旨在探讨在一家三级儿童医院实施 2013 年最佳实践指南中提到的策略前后，神经肌肉型脊柱侧凸（NMS）患者手术部位感染的发生率。
接受脊柱手术的 NMS 患者手术部位感染的风险较高。2013 年，一份针对高危儿科脊柱手术患者手术部位感染预防的最佳实践指南报告了降低发病率的策略。迄今为止，尚无研究探讨这些策略的效果。
对 NMS 患者手术部位感染进行回顾性审查。纳入 2008 年 1 月至 2012 年 12 月（第 1 组）和 2014 年 1 月至 2018 年 12 月（第 2 组）行初次后路脊柱融合术的 NMS 患者，2013 年除外为过渡年。主要结局是术后 1 年内手术部位感染的发生率，由疾病控制和国家医疗保健安全网络定义。所有患者均有至少 1 年的随访记录。
共纳入 198 例患者，第 1 组 62 例，第 2 组 136 例。年龄、BMI、性别、骨盆融合、术前 Cobb 角、尿失禁、引流管使用、失血量、手术时间和其他围手术期指标相似（P>0.05）。第 1 组发生深部手术部位感染 10 例（16.1%），第 2 组发生 6 例（4.4%）（P=0.005）。13 例（59.1%）鉴定的病原体为革兰阴性菌，其中 11 例（84.6%）来自第 1 组（P=0.047）。混合感染占所有感染的 6 例（37.5%）。
实施 2013 年最佳实践指南中提到的策略后，NMS 患者手术部位感染的发生率显著下降（16.1% vs. 4.4%）。需要进一步研究以继续降低该高危人群的发病率。
3 级
