Willigenburg Nienke W, Yesilkaya Fatih, Rutgers Marijn, Moojen Dirk Jan F, Poolman Rudolf W, Kempen Diederik H R
Department of Orthopaedic and Trauma Surgery, Joint Research, OLVG, Amsterdam, the Netherlands.
Department of Orthopaedic Surgery, LUMC, Leiden, the Netherlands.
Arthroplast Today. 2022 Nov 28;19:101053. doi: 10.1016/j.artd.2022.10.003. eCollection 2023 Feb.
Intraoperative chlorhexidine irrigation could be a valuable additive to systemic antibiotics to prevent infections after total joint arthroplasties. However, it may cause cytotoxicity and impair wound healing. This study evaluates the incidence of infection and wound leakage before and after the introduction of intraoperative chlorhexidine lavage.
All 4453 patients receiving a primary hip or knee prosthesis between 2007 and 2013 in our hospital were retrospectively included. They all underwent intraoperative lavage before wound closure. Initially, wound irrigation with 0.9% NaCl was standard care (n = 2271). In 2008, additional irrigation with a chlorhexidine-cetrimide (CC) solution was gradually introduced (n = 2182). Data on the incidence of prosthetic joint infections and wound leakage, as well as relevant baseline and surgical characteristics, were derived from medical charts. Chi-square analysis was used to compare the incidence of infection and wound leakage between patients with and without CC irrigation. Multivariable logistic regression was used to assess robustness of these effects by adjusting for potential confounders.
The prosthetic infection rate was 2.2% in the group without CC irrigation vs 1.3% in the group with CC irrigation ( = .021). Wound leakage occurred in 15.6% of the group without CC irrigation and in 18.8% of the group with CC irrigation ( = .004). However, multivariable analyses showed that both findings were likely due to confounding variables, rather than by the change in intraoperative CC irrigation.
Intraoperative wound irrigation using a CC solution does not seem to affect the risk of prosthetic joint infection or wound leakage. Observational data easily yield misleading results, so prospective randomized studies are needed to verify causal inference.
Level III-uncontrolled before and after the study.
术中使用氯己定冲洗可能是全身应用抗生素之外预防全关节置换术后感染的一种有效辅助措施。然而，它可能会引起细胞毒性并损害伤口愈合。本研究评估术中使用氯己定灌洗前后感染和伤口渗漏的发生率。
回顾性纳入2007年至2013年在我院接受初次髋关节或膝关节置换术的4453例患者。他们在伤口闭合前均接受了术中灌洗。最初，用0.9%氯化钠进行伤口冲洗是标准护理措施（n = 2271）。2008年，逐渐引入了用氯己定-西曲溴铵（CC）溶液进行的额外冲洗（n = 2182）。人工关节感染和伤口渗漏的发生率数据，以及相关的基线和手术特征，均来自病历。采用卡方分析比较接受和未接受CC冲洗患者之间的感染和伤口渗漏发生率。使用多变量逻辑回归通过调整潜在混杂因素来评估这些效应的稳健性。
未接受CC冲洗组的人工关节感染率为2.2%，而接受CC冲洗组为1.3%（P = 0.021）。未接受CC冲洗组有15.6%发生伤口渗漏，接受CC冲洗组为18.8%（P = 0.004）。然而，多变量分析表明，这两个结果可能是由于混杂变量导致的，而非术中CC冲洗的改变所致。
使用CC溶液进行术中伤口冲洗似乎不会影响人工关节感染或伤口渗漏的风险。观察性数据容易产生误导性结果，因此需要进行前瞻性随机研究来验证因果推断。
III级——非对照前后研究。
