即时使用蒸汽灭菌与骨科手术部位感染发生率的关联：一项倾向评分匹配队列研究。
The Association of Immediate-Use Steam Sterilization with the Incidence of Orthopaedic Surgical Site Infections: A Propensity Score-Matched Cohort Study.
机构信息
Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Huntington Hospital, Huntington, New York.
Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts.
出版信息
J Bone Joint Surg Am. 2022 Jun 1;104(11):988-994. doi: 10.2106/JBJS.21.01275. Epub 2022 Mar 29.
BACKGROUND
Immediate-use steam sterilization (IUSS), formerly termed "flash" sterilization, has been historically used to sterilize surgical instruments in emergency situations. Strict guidelines deter its use, as IUSS has been theorized to increase the risk of surgical site infections (SSIs), leading to increased health-care costs and poor patient outcomes. We sought to examine the association between the use of IUSS and the rate of orthopaedic SSIs.
METHODS
The cases of 70,600 patients who underwent orthopaedic surgery-total knee or hip arthroplasty, laminectomy, or spinal fusion-from January 2014 to December 2020, were retrospectively reviewed for IUSS use. Of this group, 3,526 patients had had IUSS used during surgery. A propensity score-matched (PSM) analysis was conducted to account for known predictors of SSIs and included a total of 7,052 patients. The risk difference (RD), relative risk (RR), odds ratio (OR), and McNemar test compared the SSI risk for patients whose procedure had included the use of IUSS and those whose procedure had not included IUSS.
RESULTS
After propensity score matching, 111 (1.57%) of the 7,052 matched patients developed an SSI. Of the 111 patients, 61 (54.95%) were in the IUSS group and 50 (45.05%) were in the non-IUSS group. The estimated probability for developing an SSI was 1.42% for the patients in the non-IUSS group versus 1.73% for the patients in the IUSS group (RR = 0.82 [95% confidence interval (CI)]: 0.57 to 1.19], RD = -0.3% [95% CI: -0.9% to 0.27%]).There was no evidence that the proportion of SSI was greater in the IUSS group (McNemar test, p > 0.29).
CONCLUSIONS
SSI rates were not significantly different between IUSS and non-IUSS patients undergoing orthopaedic surgery. Future prospective studies are warranted to further explore the utility of IUSS during orthopaedic procedures.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
即时使用蒸汽灭菌（IUSS），以前称为“闪蒸”灭菌，历史上用于在紧急情况下对手术器械进行灭菌。严格的指南阻止了其使用，因为理论上 IUSS 会增加手术部位感染（SSI）的风险，导致医疗保健成本增加和患者预后不良。我们试图研究使用 IUSS 与骨科 SSI 发生率之间的关联。
方法
回顾性分析了 2014 年 1 月至 2020 年 12 月期间接受骨科手术（全膝关节或髋关节置换术、椎板切除术或脊柱融合术）的 70600 例患者的病例，以了解 IUSS 的使用情况。在这组患者中，有 3526 例患者在手术中使用了 IUSS。进行倾向评分匹配（PSM）分析以考虑 SSI 的已知预测因素，共包括 7052 例患者。风险差异（RD）、相对风险（RR）、优势比（OR）和 McNemar 检验比较了接受 IUSS 治疗的患者和未接受 IUSS 治疗的患者的 SSI 风险。
结果
在进行倾向评分匹配后，7052 名匹配患者中有 111 例（1.57%）发生 SSI。在这 111 例患者中，61 例（54.95%）在 IUSS 组，50 例（45.05%）在非 IUSS 组。非 IUSS 组患者发生 SSI 的估计概率为 1.42%，而 IUSS 组患者为 1.73%（RR=0.82[95%置信区间（CI）：0.57 至 1.19]，RD=-0.3%[95%CI：-0.9%至 0.27%]）。没有证据表明 IUSS 组的 SSI 比例更高（McNemar 检验，p>0.29）。
结论
接受骨科手术的 IUSS 和非 IUSS 患者的 SSI 发生率无显著差异。需要进一步进行前瞻性研究，以进一步探讨 IUSS 在骨科手术中的应用。
证据水平
治疗水平 III。有关证据水平的完整描述，请参阅作者说明。
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