Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
Clin Orthop Relat Res. 2024 Dec 1;482(12):2163-2169. doi: 10.1097/CORR.0000000000003177. Epub 2024 Jul 15.
Surgical site infection (SSI) after foot and ankle surgery has serious negative effects on patient health and quality of life. While previous studies have looked at predisposing factors for SSI, to our knowledge, no study has proposed a risk severity score.
QUESTIONS/PURPOSES: Can a risk severity score, based on patient demographic characteristics and surgical variables, be developed for preoperative use in patients undergoing foot and ankle surgery that will calculate the risk of an irrigation and debridement (I&D) procedure within 90 days of surgery utilizing data from previous surgeries?
A retrospective chart study was performed on patients undergoing foot and ankle surgery. Data on demographic characteristics including age, sex, and BMI were recorded. Data on patient factors including diabetes and smoking history were also recorded. Surgical details including length of surgery, procedure type, surgeon, antibiotic delivery time, antibiotic type, and antibiotic dose were analyzed. Of 2979 procedures, 1% (36) of I&Ds were performed within 90 days. The mean age at surgery was 49 ± 17 years, and 57% (1702) of patients were female. The mean BMI was 28 ± 6 kg/m 2 . The primary outcome was I&D within 90 days postoperatively. Descriptive statistics of differences in patient characteristics between those who underwent I&D and those who did not were examined using chi-square tests and t-tests (p < 0.05 was taken as significant). Significant variables from a simple regression analysis were included in a multiple logistic regression model with a forward stepwise procedure for variable selection. We required all data in the model to be categorical; thus, continuous variables such as time were dichotomized. We factored odds ratios determined by multiple regression for significant variables into the final risk severity score, and an easy-to-use tool based on this risk severity score was created in Excel (Microsoft).
Current tobacco use, diabetes, and longer operative times were the only factors associated with I&D within 90 days postoperatively. A risk severity score was developed using current tobacco use, diabetes, and length of surgery greater than 60 minutes as factors. A patient with a severity score of 0 (no risk factors) had a 0.6% chance of I&D within 90 days, while a severity score of 1 indicated a 1.1% chance, a score of 2 indicated a 2.1% chance, a score of 3 indicated a 4.0% chance, and a score of 4 (all risk factors) indicated a 7.5% chance of I&D within 90 days. A spreadsheet that can be used at the point of care was created based on these findings.
Our risk severity score may help inform preoperative patient guidance and operative planning. Calculating the score in the office setting during preoperative visits can also improve communication between physician and patient. Future research should focus on validation of this risk severity score at multiple institutions.
Level III, prognostic study.
足部和踝关节手术后的手术部位感染 (SSI) 会对患者的健康和生活质量产生严重的负面影响。虽然之前的研究已经研究了 SSI 的易患因素，但据我们所知，尚无研究提出风险严重程度评分。
问题/目的：能否基于患者人口统计学特征和手术变量，为接受足部和踝关节手术的患者制定术前风险严重程度评分，以便在手术 90 天内利用之前手术的数据计算接受灌洗和清创术 (I&D) 的风险？
对接受足部和踝关节手术的患者进行回顾性图表研究。记录了人口统计学特征（包括年龄、性别和 BMI）的数据。还记录了患者因素，包括糖尿病和吸烟史。分析了手术细节，包括手术时间、手术类型、外科医生、抗生素给药时间、抗生素类型和抗生素剂量。在 2979 例手术中，有 1%（36 例）在 90 天内进行了 I&D。手术时的平均年龄为 49 ± 17 岁，57%（1702 例）为女性。平均 BMI 为 28 ± 6kg/m 2 。主要结局为术后 90 天内进行 I&D。使用卡方检验和 t 检验检查了 I&D 患者与未进行 I&D 患者之间患者特征差异的描述性统计数据（p<0.05 为显著）。简单回归分析中的显著变量被纳入具有向前逐步变量选择的多变量逻辑回归模型。我们要求模型中的所有数据均为分类数据；因此，将连续变量（如时间）二值化。我们将多回归确定的显著变量的优势比纳入最终风险严重程度评分，并在 Excel（Microsoft）中创建了一个基于该风险严重程度评分的易用工具。
当前吸烟、糖尿病和较长的手术时间是与术后 90 天内 I&D 相关的唯一因素。使用当前吸烟、糖尿病和手术时间超过 60 分钟作为因素开发了风险严重程度评分。严重程度评分为 0（无风险因素）的患者在 90 天内进行 I&D 的可能性为 0.6%，而严重程度评分为 1 的患者为 1.1%，评分为 2 的患者为 2.1%，评分为 3 的患者为 4.0%，评分为 4（所有风险因素）的患者在 90 天内进行 I&D 的可能性为 7.5%。根据这些发现创建了一个可在护理点使用的电子表格。
我们的风险严重程度评分可能有助于为术前患者指导和手术计划提供信息。在术前就诊期间在办公室计算评分也可以改善医患沟通。未来的研究应侧重于在多个机构验证该风险严重程度评分。
III 级，预后研究。
