Aneizi Ali, Kovvur Murali, Chrencik Matthew, Ng Vincent Y
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, United States.
J Orthop. 2024 Jun 8;57:40-43. doi: 10.1016/j.jor.2024.06.001. eCollection 2024 Nov.
Megaprostheses provide a reconstructive option for patients with bone loss after musculoskeletal tumor resection. However, the postoperative surgical site infection (SSI) risk is significant. This study aims to evaluate outcomes of extended postoperative antibiotic regimens in patients after megaprosthesis surgery and gather insight into strategies to minimize SSI.
This retrospective cohort study evaluated patients who underwent megaprosthesis surgery by a single surgeon at a single center from 2014 to 2022. Patient demographics, comorbidities, cancer treatment details, and antibiotic regimens were collected. Excluded were patients with less than 1 year of follow-up, active infection at time of surgery, non-healing wounds unrelated to SSI, and preoperative antibiotic regimens secondary to being immunocompromised. Measures of interest included the development of SSI within 1 year of surgery and development of antibiotic-related complications.
Included were 49 patients, with a mean age of 61.2 ± 2.0 years and a mean BMI of 29.4 ± 7.0. The mean drain duration was 6.5 days (standard deviation [SD], 6.9 days), and the mean intravenous antibiotic administration duration was 6.4 days (SD, 6.9 days). The median time to drain removal was five days, and the median time for intravenous antibiotic cessation was five days. The mean total antibiotic administration duration (intravenous and oral) was 25.4 days (SD, 13.4 days). Only 1 patient in the included cohort (2.04 %) developed an SSI requiring operative intervention. No other patient within the cohort experienced an antibiotic-related complication.
This study suggests that the site's current protocol for managing post-megaprosthesis antibiotic prophylaxis based on drain duration and incision healing status has resulted in a low rate of SSI and antibiotic-related complications. Further research is needed to validate these findings and gain additional insights into managing antibiotic prophylaxis after megaprosthesis surgery.
对于肌肉骨骼肿瘤切除术后出现骨质缺损的患者，大假体提供了一种重建选择。然而，术后手术部位感染（SSI）的风险很高。本研究旨在评估大假体手术后患者延长术后抗生素治疗方案的效果，并深入了解将SSI降至最低的策略。
这项回顾性队列研究评估了2014年至2022年在单一中心由单一外科医生进行大假体手术的患者。收集了患者的人口统计学资料、合并症、癌症治疗细节和抗生素治疗方案。排除随访时间少于1年、手术时存在活动性感染、与SSI无关的伤口不愈合以及因免疫功能低下而采用术前抗生素治疗方案的患者。感兴趣的指标包括术后1年内SSI的发生情况以及抗生素相关并发症的发生情况。
纳入49例患者，平均年龄61.2±2.0岁，平均体重指数29.4±7.0。平均引流持续时间为6.5天（标准差[SD]，6.9天），平均静脉用抗生素给药持续时间为6.4天（SD，6.9天）。引流管拔除的中位时间为5天，静脉用抗生素停用的中位时间为5天。抗生素总给药持续时间（静脉和口服）的平均值为25.4天（SD，13.4天）。纳入队列中只有1例患者（2.04%）发生了需要手术干预的SSI。队列中的其他患者均未出现抗生素相关并发症。
本研究表明，该机构目前基于引流持续时间和切口愈合状况管理大假体术后抗生素预防的方案导致SSI和抗生素相关并发症的发生率较低。需要进一步的研究来验证这些发现，并获得关于大假体手术后抗生素预防管理的更多见解。
