背景:手术部位感染(SSI)是骨科手术最常见的并发症之一,会导致发烧,疼痛,甚至危及生命的败血症.本研究旨在确定急性腿部筋膜室综合征(ALCS)患者筋膜切开术后SSI的预测因素。
方法:我们收集了2013年11月至2021年1月在两家医院接受筋膜切开术的125例ALCS患者的信息。将有SSI的患者视为SSI组,将无SSI的患者视为非SSI组。单变量分析,Logistic回归分析,和受试者工作特征(ROC)曲线分析用于评估患者的人口统计学,合并症,和入院实验室检查。
结果:在我们的研究中,SSI(125人中有26人)的发生率为20.8%。使用单变量分析发现了SSI的几个预测因子,包括体重指数(BMI)(p=0.001),开放性骨折患者(p=0.003),和有吸烟史的患者(p=0.004)。此外,中性粒细胞水平(p=0.022),葡萄糖(p=0.041),球蛋白(p=0.010),SSI组的总二氧化碳含量高于非SSI组。根据logistic回归分析的结果,开放性骨折患者(p=0.023,OR3.714),有吸烟史的患者(p=0.010,OR4.185),BMI较高的患者(p=0.014,OR1.209)是SSI的相关预测因子。此外,ROC曲线分析以24.69kg/m2作为BMI的临界值来预测SSI。
结论:我们的结果显示开放性骨折,BMI,和吸烟史作为ALCS患者筋膜切开术后SSI的独立危险因素,并确定BMI的临界值,使我们能够个性化评估SSI的风险,以实施早期靶向治疗。
BACKGROUND: Surgical site infection (SSI) is one of the most common complications of orthopedic surgery, which can result in fever, pain, and even life-threatening sepsis. This study aimed to determine the predictors of SSI after
fasciotomy in patients with acute leg compartment syndrome (ALCS).
METHODS: We collected information on 125 ALCS patients who underwent
fasciotomy in two hospitals between November 2013 and January 2021. Patients with SSI were considered as the SSI group and those without SSI as the non-SSI group. Univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analyses were used to evaluate patient demographics, comorbidities, and admission laboratory examinations.
RESULTS: In our research, the rate of SSI (26 of 125) was 20.8%. Several predictors of SSI were found using univariate analysis, including body mass index (BMI) (p = 0.001), patients with open fractures (p = 0.003), and patients with a history of smoking (p = 0.004). Besides, the levels of neutrophil (p = 0.022), glucose (p = 0.041), globulin (p = 0.010), and total carbon dioxide were higher in the SSI group than in the non-SSI group. According to the results of the logistic regression analysis, patients with open fractures (p = 0.023, OR 3.714), patients with a history of smoking (p = 0.010, OR 4.185), and patients with a higher BMI (p = 0.014, OR 1.209) were related predictors of SSI. Furthermore, ROC curve analysis indicated 24.69 kg/m2 as the cut-off value of BMI to predict SSI.
CONCLUSIONS: Our results revealed open fractures, BMI, and smoking history as independent risk factors for SSI following
fasciotomy in patients with ALCS and determined the cut-off value of BMI, enabling us to individualize the evaluation of the risk for SSI to implement early targeted treatments.