高危小儿脊柱手术部位感染的最佳实践指南：定义、预防、诊断和治疗。
Best Practice Guidelines for Surgical Site Infection in High-risk Pediatric Spine Surgery: Definition, Prevention, Diagnosis, and Treatment.
机构信息
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY.
出版信息
J Pediatr Orthop. 2022;42(10):e1008-e1017. doi: 10.1097/BPO.0000000000002255. Epub 2022 Aug 29.
BACKGROUND
Prior "best practice guidelines" (BPG) have identified strategies to reduce the risk of acute deep surgical site infection (SSI), but there still exists large variability in practice. Further, there is still no consensus on which patients are "high risk" for SSI and how SSI should be diagnosed or treated in pediatric spine surgery. We sought to develop an updated, consensus-based BPG informed by available literature and expert opinion on defining high-SSI risk in pediatric spine surgery and on prevention, diagnosis, and treatment of SSI in this high-risk population.
MATERIALS AND METHODS
After a systematic review of the literature, an expert panel of 21 pediatric spine surgeons was selected from the Harms Study Group based on extensive experience in the field of pediatric spine surgery. Using the Delphi process and iterative survey rounds, the expert panel was surveyed for current practices, presented with the systematic review, given the opportunity to voice opinions through a live discussion session and asked to vote regarding preferences privately. Two survey rounds were conducted electronically, after which a live conference was held to present and discuss results. A final electronic survey was then conducted for final voting. Agreement ≥70% was considered consensus. Items near consensus were revised if feasible to achieve consensus in subsequent surveys.
RESULTS
Consensus was reached for 17 items for defining high-SSI risk, 17 items for preventing, 6 for diagnosing, and 9 for treating SSI in this high-risk population. After final voting, all 21 experts agreed to the publication and implementation of these items in their practice.
CONCLUSIONS
We present a set of updated consensus-based BPGs for defining high-risk and preventing, diagnosing, and treating SSI in high-risk pediatric spine surgery. We believe that this BPG can limit variability in practice and decrease the incidence of SSI in pediatric spine surgery.
LEVEL OF EVIDENCE
Not applicable.
背景
先前的“最佳实践指南”（BPG）已经确定了降低急性深部手术部位感染（SSI）风险的策略，但实践中仍然存在很大的差异。此外，对于哪些患者是 SSI 的“高风险”，以及在小儿脊柱手术中应如何诊断和治疗 SSI，仍然没有共识。我们旨在通过对小儿脊柱手术中高 SSI 风险的定义以及该高风险人群中 SSI 的预防、诊断和治疗的现有文献和专家意见，制定一个更新的、基于共识的 BPG。
材料和方法
在对文献进行系统回顾后，根据在小儿脊柱手术领域的丰富经验，从 Harms 研究小组中选择了 21 名小儿脊柱外科专家组成一个专家小组。使用 Delphi 流程和迭代调查轮次，对专家小组进行了当前实践的调查，向他们展示了系统综述，为他们提供了通过现场讨论环节表达意见的机会，并要求他们私下投票表达对偏好的意见。进行了两轮电子调查，之后举行了现场会议以展示和讨论结果。然后进行了最后一轮电子调查，以进行最终投票。共识≥70%被认为是达成共识。如果可行，对接近共识的项目进行修订，以便在后续调查中达成共识。
结果
在定义高 SSI 风险、预防、诊断和治疗该高风险人群的 SSI 方面，有 17 项、17 项、6 项和 9 项达成了共识。最终投票后，所有 21 名专家都同意在他们的实践中公布和实施这些项目。
结论
我们提出了一组更新的基于共识的 BPG，用于定义高风险和预防、诊断和治疗小儿脊柱手术中的 SSI。我们相信，该 BPG 可以限制实践中的变异性，降低小儿脊柱手术中的 SSI 发生率。
证据水平
不适用。
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