Neurocenter, Neurointensive Care Unit, Regional Hospital, Husova 357/10, 46063, Liberec, Czech Republic.
First Medical Faculty, Institute of Physiology, Charles University, Prague, Czech Republic.
BMC Anesthesiol. 2022 Apr 27;22(1):123. doi: 10.1186/s12871-022-01673-x.
Transoral spine surgery is specific due to both its surgical approach and the spectrum of diseases it targets. Patients with high age and elevated clinical frailty scores are often involved, and there are reports of increased risks of surgical site infection (SSI) due to extended exposures requiring maxilotomy or mandibulotomy. Our case series describes surgical wound complications under the meticulous application of individualized perioperative multimodal management.
Our primary outcome was the occurrence of SSI and the secondary outcome was the occurrence of other noninfectious wound complications evaluated in 22 adult patients who consecutively underwent the transoral spine surgery from 2001 to 2018 (trauma - C2, cervical nonunion: 6 patients, 27%; tumor: 4 patients, 18%; osteomyelitis: 6 patients, 27%; other non-traumatic cases: 6 patients, 27%). Structuralized data comprising parameters related to nosocomial infections after spine surgery were continuously processed and put into specialized database of preventive multimodal nosocomial infection control protocol that was used as a main source of analyzed parameters. The mean age of studied cohort was 54.9 [Formula: see text] 15.5 years, with 68% males, mean body mass index (BMI) 24.9 [Formula: see text] 5.22, and the mean clinical frailty score was 2.59 [Formula: see text] 1.07. There were 7 patients (32%) who only had the transoral approach and 15 patients (68%) having this approach followed by additional posterior approach. We observed SSI from all wound complications for up to one year after surgery.
There were 4 (18%) superficial wound complications from transoral approach, but none of them were infected. We had 2 patients (13%) with deep wound infections after subsequent posterior approach, but only one (4.5%) was classified as SSI.
We describe the wound complications and the incidence of SSI in a series of 22 patients after the transoral surgery. Considering the average values of the clinical frailty score reaching 2.59, American Society of Anesthesiologists score of 2.73, and the BMI of 26.87, the transoral spine surgery did not seem to be a considerable risk for SSI in the analyzed cohort, provided preventive perioperative multimodal management is properly individualized and followed.
经口脊柱手术具有其独特性，这与其手术入路和针对的疾病谱有关。该手术涉及的患者通常年龄较大，临床虚弱评分较高，有报道称，由于需要行上颌骨切开术或下颌骨切开术来延长暴露，手术部位感染（SSI）的风险增加。本病例系列描述了在个体化围手术期多模式管理的精心应用下手术伤口并发症的情况。
我们的主要结局是 SSI 的发生，次要结局是评估 2001 年至 2018 年间连续接受经口脊柱手术的 22 例成年患者的其他非感染性伤口并发症的发生情况（创伤-C2、颈椎不愈合：6 例，27%；肿瘤：4 例，18%；骨髓炎：6 例，27%；其他非创伤性病例：6 例，27%）。与脊柱手术后医院感染相关的参数构成结构化数据，不断进行处理，并输入预防性多模式医院感染控制方案的专门数据库，该方案是分析参数的主要来源。研究队列的平均年龄为 54.9 [公式：见文本] 15.5 岁，男性占 68%，平均体重指数（BMI）为 24.9 [公式：见文本] 5.22，平均临床虚弱评分为 2.59 [公式：见文本] 1.07。7 例（32%）患者仅行经口入路，15 例（68%）患者行经口入路后行附加后路入路。我们观察了手术后长达 1 年的所有伤口并发症的 SSI。
经口入路有 4 例（18%）出现浅表伤口并发症，但均无感染。随后后路入路有 2 例（13%）深部伤口感染，但仅有 1 例（4.5%）为 SSI。
我们描述了 22 例经口手术后患者的伤口并发症和 SSI 的发生率。考虑到临床虚弱评分的平均值达到 2.59、美国麻醉医师协会评分 2.73 和 BMI 为 26.87，在分析的队列中，经口脊柱手术似乎不会对 SSI 产生相当大的风险，只要适当个体化并遵循围手术期多模式预防措施。
