手外科在手术室环境中是否与手术部位感染增加有关？一项在退伍军人事务人群中对 2717 例患者进行的队列研究。
Is Hand Surgery in the Procedure Room Setting Associated With Increased Surgical Site Infection? A Cohort Study of 2,717 Patients in the Veterans Affairs Population.
机构信息
Department of Orthopedic Surgery, University of Pennsylvannia, Philadelphia, PA.
Department of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA.
出版信息
J Hand Surg Am. 2023 Jun;48(6):559-565. doi: 10.1016/j.jhsa.2023.03.001. Epub 2023 Mar 25.
PURPOSE
Procedure rooms (PRs) are increasingly used for hand surgeries, but few studies have directly compared surgical site infection (SSI) rates between the PR and operating room. We tested the hypothesis that procedure setting is not associated with an increased SSI incidence in the VA population.
METHODS
We identified carpal tunnel, trigger finger, and first dorsal compartment releases performed at our VA institution from 1999 to 2021 of which 717 were performed in the main operating room and 2,000 were performed in the PR. The incidence of SSI, defined as signs of wound infection within 60 days of the index procedure, which was treated with oral antibiotics, intravenous antibiotics, and/or operating room irrigation and debridement, was compared. We constructed a multivariable logistic regression analysis to assess the association between procedure setting and SSI incidence, adjusting for age, sex, procedure type, and comorbidities.
RESULTS
Surgical site infection incidence was 55/2,000 (2.8%) in the PR cohort and 20/717 (2.8%) in the operating room cohort. In the PR cohort, five (0.3%) cases required hospitalization for intravenous antibiotics of which two (0.1%) cases required operating room irrigation and debridement. In the operating room cohort, two (0.3%) cases required hospitalization for intravenous antibiotics of which one (0.1%) case required operating room irrigation and debridement. All other SSIs were treated with oral antibiotics alone. The procedure setting was not independently associated with SSI (adjusted odds ratio, 0.84 [95% confidence interval, 0.49, 1.48]). The only risk factor for SSI was trigger finger release (odds ratio, 2.13 [95% confidence interval, 1.32, 3.48] compared with carpal tunnel release), which was independent of setting.
CONCLUSIONS
Minor hand surgeries can be performed safely in the PR without an increased rate of SSI.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
目的
程序室（PR）越来越多地用于手部手术，但很少有研究直接比较 PR 和手术室的手术部位感染（SSI）发生率。我们检验了这样一个假设，即程序设置与退伍军人事务部人群的 SSI 发生率增加无关。
方法
我们从 1999 年至 2021 年确定了在我们退伍军人事务部机构进行的腕管松解术、扳机指松解术和第一背侧间隔松解术，其中 717 例在主手术室进行，2000 例在 PR 进行。SSI 的发生率定义为索引手术后 60 天内出现的伤口感染迹象，这些感染通过口服抗生素、静脉内抗生素和/或手术室冲洗和清创进行治疗，对其进行比较。我们构建了多变量逻辑回归分析来评估程序设置与 SSI 发生率之间的关联，调整了年龄、性别、手术类型和合并症。
结果
在 PR 队列中，SSI 发生率为 55/2000（2.8%），在手术室队列中为 20/717（2.8%）。在 PR 队列中，有 5 例（0.3%）需要住院接受静脉内抗生素治疗，其中 2 例（0.1%）需要手术室冲洗和清创。在手术室队列中，有 2 例（0.3%）需要住院接受静脉内抗生素治疗，其中 1 例（0.1%）需要手术室冲洗和清创。所有其他 SSI 均单独使用口服抗生素治疗。程序设置与 SSI 无独立相关性（调整后的优势比，0.84 [95%置信区间，0.49，1.48]）。SSI 的唯一危险因素是扳机指松解术（与腕管松解术相比，优势比为 2.13 [95%置信区间，1.32，3.48]），这与设置无关。
结论
PR 中可以安全地进行小型手部手术，而不会增加 SSI 发生率。
研究类型/证据水平：预后 II 级。
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