University Hospitals of Leicester NHS Trust, Leicester, UK.
Ann R Coll Surg Engl. 2021 May;103(5):345-353. doi: 10.1308/rcsann.2020.7085. Epub 2021 Apr 14.
Persistent wound leakage following joint arthroplasty is a known risk for periprosthetic joint infection. Little is known of the predictors of wound leakage, particularly in patients with a fractured neck of femur. We aimed to determine patient and surgical risk factors for wound leakage in this cohort.
All patients undergoing surgery for a fractured neck of femur at Leicester Royal Infirmary between May and August 2017 were included. Patients were identified from a prospective database and placed into two groups: those with wound leakage later than three days postoperatively and those without leakage. All previously reported potential risk factors for wound leakage were compared between groups using a chi-square test and logistic regression. A Kattan-style nomogram was also created to allow probabilities output for the regression predictive models in a visual representation.
Two hundred patients underwent surgery for a fractured neck of femur. Overall, 17% of patients (33/200) developed a persistent leaky wound. A multivariable model highlighted increased age ( = 0.01), raised body mass index (BMI; > 25 kg/m; = 0.047), diabetes ( = 0.03) and intramedullary hip screw fixation ( = 0.03) as significant risk factors for wound leakage. Patients with persistent wound leakage had significantly longer hospital admission than those without ( = 0.001).
Our analysis identified four perioperative risk factors for wound leakage following fractured neck of femur surgery. We also developed a novel tool to identify those patients at highest risk of leakage. Once identified, the aggressive management of certain medical comorbidities in these patients may help to reduce their incidence of wound issues and the prolonged admissions that result.
关节置换术后持续的伤口渗漏是假体周围关节感染的已知风险。对于伤口渗漏的预测因素知之甚少，尤其是在股骨颈骨折患者中。我们旨在确定该队列中患者和手术的伤口渗漏风险因素。
纳入 2017 年 5 月至 8 月在莱斯特皇家医院接受股骨颈骨折手术的所有患者。从前瞻性数据库中识别患者，并将其分为两组：术后 3 天以上出现伤口渗漏的患者和无渗漏的患者。使用卡方检验和逻辑回归比较两组之间所有先前报道的伤口渗漏潜在风险因素。还创建了 Kattan 风格的列线图，以便以可视化表示输出回归预测模型的概率。
200 例患者接受了股骨颈骨折手术。总体而言，17%的患者（33/200）出现持续渗漏性伤口。多变量模型突出了年龄增加（=0.01）、体重指数（BMI；>25kg/m；=0.047）、糖尿病（=0.03）和髓内髋螺钉固定（=0.03）是伤口渗漏的显著危险因素。与无渗漏的患者相比，持续性伤口渗漏的患者住院时间明显更长（=0.001）。
我们的分析确定了股骨颈骨折手术后伤口渗漏的四个围手术期危险因素。我们还开发了一种新工具来识别那些具有最高渗漏风险的患者。一旦确定，积极管理这些患者的某些医疗合并症可能有助于降低伤口问题的发生率和由此导致的住院时间延长。
