目的:手术部位感染(SSI)与较高的医疗费用和较低的患者生活质量有关。这项研究旨在确定创伤引起的骨折骨科手术后SSI的特定可改变的危险因素。
方法:这项巢式病例对照研究使用了全国性的创伤登记处,日本创伤数据库(JTDB)数据库。
方法:从JTDB检索了2004年1月至2019年5月期间来自280家医院的患者数据。我们纳入有SSI的患者和无SSI的身份患者作为对照受试者,使用针对不可改变因素进行调整的倾向评分匹配。使用多级混合效应逻辑回归模型评估骨科创伤手术后与SSI相关的危险因素。
结果:总计,15,910名患者被纳入分析。在这些病人中,377(2.4%)患有SSI。在倾向得分匹配后,选择258例SSI患者和2,580例无SSI的匹配患者。在多水平混合效应逻辑回归分析中,24小时内输血(比值比[OR],1.51;95%置信区间[CI],1.06-2.13)是骨科骨折手术后SSI的重要危险因素。外固定架的OR,经导管动脉栓塞,骨科骨折手术后SSI的止血带为1.40(95%CI,0.96-2.03),1.66(95%CI,0.81-3.38),和2.99(95%CI,0.60-14.87),分别。
结论:这些研究结果强调了在24小时内实施输血时谨慎行事的必要性,这是骨科创伤手术后发生SSI的一个危险因素。
BACKGROUND: Surgical site infection (SSI) is associated with higher medical expenses and lower patient quality of life.
OBJECTIVE: To identify specific modifiable risk factors for SSI after orthopaedic surgery for fractures caused by trauma.
METHODS: This nested
case-control study used a nationwide trauma registry, the Japan Trauma Data Bank (JTDB) database. Patient data from 280 hospitals between January 2004 and May 2019 were retrieved from the JTDB. Patients with SSI and identified patients without SSI as control subjects were included, using propensity score matching adjusted for unmodifiable factors. Risk factors associated with SSI after orthopaedic trauma surgery were assessed using multi-level mixed-effects logistic regression models.
RESULTS: In total, 15,910 patients were included in the analysis. Of these patients, 377 (2.4%) had SSI. After propensity score matching, 258 patients with SSI and 2580 matched patients without SSI were selected. In the multi-level mixed-effects logistic regression analysis, blood transfusion within 24 h (odds ratio (OR): 1.51; 95% confidence interval (CI): 1.06-2.13) was a significant risk factor for SSI following orthopaedic fracture surgery. The OR (95% CI) values for external fixation, transcatheter arterial embolization, and tourniquet for SSI following orthopaedic fracture surgery were 1.40 (0.96-2.03), 1.66 (0.81-3.38), and 2.99 (0.60-14.87), respectively.
CONCLUSIONS: These findings highlight the necessity of exercising caution when implementing blood transfusion within 24 h as a risk factor associated with SSI following orthopaedic trauma surgery.