Choudhri Tanvir F, Li Adam Y, Ali Muhammad, Spiera Zachary, Marayati Naoum Fares, Schupper Alexander J, Durbin John, Asghar Nek, Dreher Nickolas, Hannah Theodore, Sayegh Farah, Bellaire Christopher, Harmaty Marco A, Torina Philip, Ting Jess, Taub Peter J
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Plast Surg (Oakv). 2024 Aug;32(3):445-451. doi: 10.1177/22925503221120542. Epub 2022 Sep 1.
Reduction of surgical site infections (SSIs) is important in improving cervical spine surgery outcomes. Plastic surgery involvement and an enhanced modified prophylaxis protocol may reduce infection rates. A total of 962 cervical spine operations were conducted by a single surgeon (TFC). An enhanced modified prophylaxis protocol and plastic surgery were used in some operations. Differences in infection rates, surgical approach, previous operations, prophylaxis use, and plastic surgery involvement were compared using Fisher's exact tests and multivariate linear regression. Four patients (0.42%) experienced SSIs. All 4 infections involved the standard protocol, posterior approach, and did not involve plastic surgery. The infection rate was lower in the enhanced protocol group when compared to the standard protocol (β -0.78, 95% CI -1.23 to -0.33, = .0008). The enhanced protocol group had an increased percentage of operations with plastic surgery (β 0.19, 95% CI 0.10 to 0.28, < .0001). The infection rate among the plastics group was 0.00% compared to 0.60% for the non-plastics group ( = .32). The plastics group had a lower rate of anterior approach when compared to the non-plastics group (β -0.20, 95% CI -0.24 to -0.15, = .049). Among the posterior approach group, procedures with plastic surgery had an infection rate of 0.00% compared to 2.53% without plastic surgery ( = .13). The enhanced protocol was associated with a lower SSI rate and increased plastic surgery involvement. Posterior approaches were associated with increased infection rates and the likelihood of utilizing plastic surgery. Both the enhanced protocol and plastic surgery may decrease infection.
降低手术部位感染（SSIs）对于改善颈椎手术效果至关重要。整形外科的参与和强化的改良预防方案可能会降低感染率。一位外科医生（TFC）共进行了962例颈椎手术。部分手术采用了强化的改良预防方案并涉及整形外科。使用Fisher精确检验和多元线性回归比较了感染率、手术方式、既往手术、预防措施使用情况以及整形外科参与情况的差异。4例患者（0.42%）发生了手术部位感染。所有4例感染均涉及标准方案、后路手术，且未涉及整形外科。与标准方案组相比，强化方案组的感染率较低（β -0.78，95%可信区间 -1.23至-0.33，P = 0.0008）。强化方案组涉及整形外科手术的比例有所增加（β 0.19，95%可信区间0.10至0.28，P < 0.0001）。整形外科组的感染率为0.00%，而非整形外科组为0.60%（P = 0.32）。与非整形外科组相比，整形外科组的前路手术率较低（β -0.20，95%可信区间 -0.24至-0.15，P = 0.049）。在后路手术组中，涉及整形外科手术的手术感染率为0.00%，未涉及整形外科手术的为2.53%（P = 0.13）。强化方案与较低的手术部位感染率和增加的整形外科参与相关。后路手术与感染率增加以及采用整形外科手术的可能性相关。强化方案和整形外科手术均可能降低感染率。
