Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
World Neurosurg. 2022 Jun;162:e91-e98. doi: 10.1016/j.wneu.2022.02.079. Epub 2022 Feb 25.
To determine if a penicillin allergy is an independent risk factor for poor outcomes after anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF).
A retrospective database review was performed using the PearlDiver data set. The study population included all patients younger than 85 years who underwent elective PLF or ACDF with diagnosis of penicillin allergy using International Classification of Diseases codes. Study patients were compared with controls for 90-day complications and 1-year reoperation rates. A multivariate logistic regression was used to determine the independent effect of penicillin allergy on the postoperative outcomes.
PLF cohort multivariate analysis showed that patients with a penicillin allergy had a significantly increased risk of sepsis (2.6% vs. 2.0%; P = 0.020), urinary tract infection (10.8% vs. 8.4%; P < 0.001), emergency room visits (27.3% vs. 20.2%; P < 0.001), and readmissions (9.6% vs. 6.4%; P < 0.001) within 90 days index of surgery. Similarly, the ACDF cohort multivariate analysis showed that a penicillin allergy was associated with an increased risk of sepsis (1.8% vs. 1.1%; P < 0.001), emergency room visits (27.2% vs. 20.7%; P < 0.001), and readmissions (6.8% vs. 5.6%; P = 0.003) within 90 days index of surgery.
The present study found that a reported penicillin allergy is associated with an increase in sepsis, urinary tract infection, emergency room visit, and readmission postoperatively within 90 days after PLF and ACDF. The findings can help physicians provide patients with more comprehensive preoperative counseling in the setting of patient-reported penicillin allergy.
确定青霉素过敏是否为颈椎前路椎间盘切除融合术（ACDF）和腰椎后路融合术（PLF）后不良结局的独立危险因素。
使用 PearlDiver 数据集进行回顾性数据库研究。研究人群包括所有年龄小于 85 岁的患者，这些患者因使用国际疾病分类代码诊断为青霉素过敏而行选择性 PLF 或 ACDF。将研究患者与对照组进行比较，以评估 90 天并发症和 1 年再次手术率。采用多变量逻辑回归确定青霉素过敏对术后结果的独立影响。
PLF 队列的多变量分析显示，青霉素过敏患者发生脓毒症的风险显著增加（2.6%比 2.0%；P=0.020）、尿路感染（10.8%比 8.4%；P<0.001）、急诊就诊（27.3%比 20.2%；P<0.001）和住院再入院（9.6%比 6.4%；P<0.001）的风险更高。同样，ACDF 队列的多变量分析显示，青霉素过敏与脓毒症（1.8%比 1.1%；P<0.001）、急诊就诊（27.2%比 20.7%；P<0.001）和住院再入院（6.8%比 5.6%；P=0.003）的风险增加相关。
本研究发现，报告的青霉素过敏与 PLF 和 ACDF 后 90 天内脓毒症、尿路感染、急诊就诊和再入院的发生率增加相关。这些发现有助于医生在患者报告青霉素过敏的情况下为患者提供更全面的术前咨询。
