Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States.
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States.
Clin Neurol Neurosurg. 2024 Oct;245:108505. doi: 10.1016/j.clineuro.2024.108505. Epub 2024 Aug 12.
Retrospective cohort study.
Surgical infections are unfortunately a fairly common occurrence in spine surgery, with rates reported as high as 16 %. However, there is a relative paucity of studies that look to understand how surgical infections may impact outcome variables. The aim of this study was to assess the impact of surgical infection on other perioperative complications, extended hospital length of stay (LOS), discharge disposition, and unplanned readmission following spine surgery.
A retrospective cohort study was performed using the 2016-2022 ACS NSQIP database. Adults receiving spine surgery for trauma, degenerative disease, and tumors were identified using CPT and ICD-9/10 codes. Patients were divided into two cohorts: surgical infection (superficial surgical site infection, deep surgical site infection, organ space surgical site infection, or wound dehiscence) and no surgical infection (those who did not experience any infection). Patient demographics, comorbidities, intraoperative variables, postoperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analysis was utilized to identify predictors of AEs, extended hospital length of stay, non-routine discharge, and unplanned readmission.
In our cohort of 410,930 patients, 7854 (2.2 %) were found to have experienced a surgical infection. Regarding preoperative variables, a greater proportion of the surgical infection cohort was a female (p < 0.001) and had a higher mean BMI (p < 0.001), greater frailty and ASA scores (p < 0.001), and higher rates of all presenting comorbidities included in the study. Rates of AEs (p < 0.001), unplanned readmission (p < 0.001), reoperation (p < 0.001), non-home discharge (p < 0.001), and 30-day mortality were all greater in the surgical infection group when compared to the group without surgical infection. On multivariate analysis, surgical infection was found to be an independent predictor of experiencing postoperative complications [aOR: 6.15, 95 % CI: (5.72, 6.60), p < 0.001], prolonged LOS [2.71, 95 % CI: (2.54, 2.89), p < 0.001], non-routine discharge [aOR: 1.74, 95 % CI: (1.61, 1.88), p < 0.001], and unplanned readmission [aOR: 22.57, 95 % CI: (21.06, 24.19), p < 0.001].
Our study found that surgical infection increases the risk of complications, extended LOS, non-routine discharge, and unplanned readmission. Such findings warrant further studies that aim to validate these results and identify risk factors for surgical infections.
回顾性队列研究。
手术感染在脊柱手术中是一个较为常见的问题，其发生率高达 16%。然而，很少有研究试图了解手术感染可能如何影响术后并发症变量。本研究旨在评估手术感染对其他围手术期并发症、延长住院时间（LOS）、出院去向和脊柱手术后计划外再入院的影响。
使用 2016-2022 年 ACS NSQIP 数据库进行回顾性队列研究。使用 CPT 和 ICD-9/10 代码识别接受创伤、退行性疾病和肿瘤脊柱手术的成年人。患者分为两组：手术感染（浅表手术部位感染、深部手术部位感染、器官间隙手术部位感染或伤口裂开）和无手术感染（未发生任何感染的患者）。评估患者的人口统计学、合并症、术中变量、术后不良事件（AE）和医疗资源利用情况。采用多变量逻辑回归分析确定 AE、延长住院时间、非常规出院和计划外再入院的预测因素。
在我们的 410930 名患者队列中，发现 7854 名（2.2%）发生了手术感染。在术前变量方面，手术感染组中女性比例更高（p < 0.001），平均 BMI 更高（p < 0.001），脆弱性和 ASA 评分更高（p < 0.001），且所有纳入研究的现有合并症的发生率更高。与无手术感染组相比，AE 发生率（p < 0.001）、计划外再入院率（p < 0.001）、再次手术率（p < 0.001）、非家庭出院率（p < 0.001）和 30 天死亡率均更高。多变量分析发现，手术感染是术后并发症的独立预测因素[比值比：6.15，95%置信区间：（5.72，6.60），p < 0.001]、延长 LOS[2.71，95%置信区间：（2.54，2.89），p < 0.001]、非常规出院[aOR：1.74，95%CI：（1.61，1.88），p < 0.001]和计划外再入院[aOR：22.57，95%CI：（21.06，24.19），p < 0.001]。
本研究发现手术感染增加了并发症、延长 LOS、非常规出院和计划外再入院的风险。这些发现需要进一步的研究来验证这些结果，并确定手术感染的风险因素。
