Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan.
J Hand Surg Asian Pac Vol. 2022 Aug;27(4):691-697. doi: 10.1142/S2424835522500709. Epub 2022 Aug 11.
Identification of the risk factors for surgical site infection (SSI) can be a straightforward and cost-effective measure to reduce or prevent the occurrence of SSI. However, there are no studies that revealed risk factors for SSI for traumatic upper extremity amputation. The aim of this study is to investigate the risk factors that promote SSI after surgery for traumatic upper extremity amputation using a large nationwide database. We used data from the Japan Trauma Data Bank. Diagnoses were defined using the Abbreviated Injury Scale code. We applied multivariate logistic regression to evaluate the infection risk factor. We chose age, sex, vital signs, cause and type of trauma, concomitant injury, diabetes, amputation level, Glasgow coma scale, Injury Severity Score (ISS) and blood transfusion within 24 hours following hospital arrival as confounders. Receiver operating characteristic (ROC) curve analysis was adopted to identify thresholds for change in infection risk. We also applied propensity score (PS) matching to adjust for confounding factors that may affect the outcome. A total of 1,150 patients (967 males, 183 females) had traumatic upper extremity amputation. The mean patient age was 46.5 years. A total of 21 patients (1.8%) suffered from SSI. ISS, blood transfusion, systolic blood pressure (BP) and the upper extremity amputation except for finger were identified as the independent significant risk factors for SSI occurrence by the multivariate analysis ( < 0.05, < 0.005, < 0.05 and < 0.005, respectively). ROC modelling revealed that patients with ISS of over 9 or systolic BP of over 160 had a risk for SSI. After PS matching, the patients with blood transfusion or systolic BP of over 160 had a significantly higher risk of infection (OR 9.0; = 0.01 and OR 7.0; = 0.03, respectively). In treating patients with these risk factors, we must be especially careful in performing thorough debridement and wound care. Level II (Therapeutic).
识别手术部位感染（SSI）的风险因素可能是一种简单且具有成本效益的措施，可以降低或预防 SSI 的发生。然而，目前尚无研究揭示外伤性上肢截肢术后 SSI 的风险因素。本研究旨在使用大型全国性数据库调查外伤性上肢截肢术后促进 SSI 的风险因素。
我们使用了日本创伤数据库的数据。诊断使用缩写损伤量表代码定义。我们应用多变量逻辑回归来评估感染风险因素。我们选择年龄、性别、生命体征、创伤原因和类型、合并伤、糖尿病、截肢水平、格拉斯哥昏迷量表、损伤严重程度评分（ISS）和入院后 24 小时内输血作为混杂因素。采用接收者操作特征（ROC）曲线分析确定感染风险变化的阈值。我们还应用倾向评分（PS）匹配来调整可能影响结果的混杂因素。
共有 1150 例（967 例男性，183 例女性）患者行外伤性上肢截肢术。患者平均年龄为 46.5 岁。共有 21 例（1.8%）患者发生 SSI。多变量分析显示，ISS、输血、收缩压（BP）和除手指以外的上肢截肢是 SSI 发生的独立显著危险因素（<0.05，<0.005，<0.05 和<0.005）。ROC 模型显示，ISS 超过 9 分或收缩压超过 160mmHg 的患者有 SSI 风险。PS 匹配后，输血或收缩压超过 160mmHg 的患者感染风险显著增加（OR9.0；=0.01 和 OR7.0；=0.03）。
在治疗这些有风险的患者时，我们必须特别小心进行彻底清创和伤口护理。
二级（治疗）。
