Department of Surgical Sciences/Orthopaedics, Uppsala University, Uppsala, Sweden
Department of Surgical Sciences/Orthopaedics, Uppsala University, Uppsala, Sweden.
BMJ Open. 2022 Sep 19;12(9):e060754. doi: 10.1136/bmjopen-2022-060754.
Superficial surgical site infection (SSSI) may increase the risk of serious complications such as periprosthetic joint infection (PJI). This study aims to identify patient-related risk factors associated with SSSI and investigate their correlation with the progression of PJI.
In this retrospective study, 1191 elective hip and knee prostheses were included. Patients were interviewed 3-5 months after surgery to answer questions about the postoperative period. Patient records were reviewed to determine whether there had been any documentation of wound-healing difficulties or whether antibiotics were prescribed to treat an infection related to arthroplasty surgery.
Uppsala University Hospital, patients treated between November 2008 and December 2012.
The study population comprised 433 knees and 758 hips.
We studied patient-related risk factors (joint, age, sex, the American Society of Anesthesiologists (ASA) classification, body mass index (BMI), smoking, diabetes and rheumatic disease) to determine whether they were associated with (1) SSSI and (2) the progress from SSSI to PJI.
84 (7%) patients of the total cohort developed SSSI. This infection progressed to a PJI in 24 (29%) of the patients. Factors with increased adjusted risk ratios (aRRs) for SSSIs were knee surgery (1.7; 95% CI: 1.1 to 2.7), age≥65 years (1.7; 95% CI: 1.1 to 2.8), BMI≥30 (1.9; 95% CI: 1.0 to 3.4) and ASA classification≥3 (1.7; 95% CI: 1.0 to 2.9). ASA classification≥3 was the only factor showing a significant progression from SSSI to PJI (aRR=3.3; 95% CI: 1.0 to 10.3).
The risk of progressing from an SSSI to a PJI is high. Older patients, patients with obesity, and those with a high ASA classification considered for elective total knee arthroplasty seem to have an increased risk of developing SSSI. Patients with a high ASA classification seem to have an increased risk of progressing from SSSI to PJI.
表浅手术部位感染（SSSI）可能会增加假体周围关节感染（PJI）等严重并发症的风险。本研究旨在确定与 SSSI 相关的患者相关危险因素，并探讨其与 PJI 进展的相关性。
在这项回顾性研究中，纳入了 1191 例择期髋关节和膝关节假体。术后 3-5 个月对患者进行访谈，以回答有关术后期间的问题。回顾患者记录，以确定是否有任何关于伤口愈合困难的记录，或是否开具抗生素治疗与关节置换手术相关的感染。
乌普萨拉大学医院，2008 年 11 月至 2012 年 12 月期间接受治疗的患者。
研究人群包括 433 例膝关节和 758 例髋关节。
我们研究了与患者相关的危险因素（关节、年龄、性别、美国麻醉师协会（ASA）分类、体重指数（BMI）、吸烟、糖尿病和风湿性疾病），以确定它们是否与（1）SSSI 和（2）从 SSSI 进展为 PJI 相关。
在总队列中，84（7%）例患者发生 SSSI。该感染在 24（29%）例患者中进展为 PJI。膝关节手术（1.7；95%CI：1.1 至 2.7）、年龄≥65 岁（1.7；95%CI：1.1 至 2.8）、BMI≥30（1.9；95%CI：1.0 至 3.4）和 ASA 分类≥3（1.7；95%CI：1.0 至 2.9）是 SSSI 发生风险增加的调整后风险比（aRR）因素。ASA 分类≥3 是唯一显示从 SSSI 进展为 PJI 的显著进展的因素（aRR=3.3；95%CI：1.0 至 10.3）。
从 SSSI 进展为 PJI 的风险很高。择期全膝关节置换术的老年患者、肥胖患者和 ASA 分类较高的患者似乎有发生 SSSI 的风险增加。ASA 分类较高的患者似乎有从 SSSI 进展为 PJI 的风险增加。
