背景:手术部位感染(SSI)是脊柱融合术后常见的并发症之一。不幸的是,几项研究显示,关于外科预防性抗菌药物(SAP)给药的最佳时机,结果相互矛盾.由于人口同质性和样本量的限制,这些研究没有提供显著的统计学相关性或明确的实际建议.
目的:本研究的目的是探讨头孢呋辛SAP治疗时机对脊柱融合术患者SSI风险的影响,并确定最佳给药时机。
方法:回顾性巢式病例对照研究。
方法:我们回顾性分析了2011年10月至2021年10月在我们机构接受脊柱融合手术的连续患者。
方法:在目前的研究中,主要结局指标为SSI.
方法:这是一项回顾性巢式病例对照研究。2011年10月至2021年10月在我们机构接受脊柱融合手术的所有连续患者组成了回顾性队列。对于每个SSI案例,选择了两个在相应病例的索引日期时没有SSI的对照,与年龄相匹配,性别,和日历年。电子记录和射线照相数据在电子数据库中进行了回顾性审查。SAP相关数据包括管理时间,术前剂量,术中第二剂量,和术后使用。为了检查不匹配变量的影响,我们使用条件逻辑回归模型进一步调整了可能的混杂因素.随后,我们进行了亚组分析,以评估统计学关联的稳健性.
结果:根据预先计划的统计方案和匹配因素,我们匹配了这些SSI病例的236个对照,随后对这354例患者进行了统计学分析.在调整混杂因素后,结果表明,与切口前0~30分钟接受SAP组相比,切口前31~60分钟接受SAP组发生SSI的风险高70%(OR=1.732,95CI1.031~2.910,P=0.038).此外,与切口前0~30分钟接受SAP组相比,切口前61~120分钟接受SAP组发生SSI的风险高出150%(OR=2.532,95CI1.250~5.128,P=0.010).在亚组分析中,这一统计趋势在畸形手术和不同的SSI分类中均存在.
结论:在皮肤切开前30分钟内服用头孢呋辛可显著降低SSI的风险,无论它们是深的还是浅的,脊柱融合手术。这种模式在脊柱畸形患者中保持一致。
BACKGROUND: Surgical site infections (SSI) are one of the common complications following spinal fusion surgery. Unfortunately, several studies had shown conflicting results regarding optimal timing of surgical antimicrobial prophylaxis (SAP) administration. Due to limitations in population homogeneity and sample size, these studies have not provided significant statistical correlations or clear practical recommendations.
OBJECTIVE: The purpose of the study was to investigate the impact of timing of cefuroxime SAP on the risk of SSI in patients undergoing spinal fusion surgery, and to determine the optimal timing of administration.
METHODS: Retrospective nested case-control study.
METHODS: We retrospectively analyzed consecutive patients who underwent spinal fusion surgery at our institution between October 2011 and October 2021.
METHODS: In the current study, the primary outcome measure was SSI.
METHODS: This was a retrospective nested case-control study. All consecutive patients who underwent spinal fusion surgery at our institution between October 2011 and October 2021 formed a retrospective cohort. For each SSI case, 2 controls free of SSI at the time of the index date of their corresponding case were selected, matched by age, sex, and calendar year. Electronic record and radiographic data were reviewed retrospectively in electronic database. SAP related data included timing of administration, preoperative dose, intraoperative second dose, and postoperative use. To examine the effects of mismatched variables, we further adjusted for possible confounding factors using conditional logistic regression models. Subsequently, subgroup analyses were conducted to assess the robustness of the statistical associations.
RESULTS: According to the preplanned statistical scheme and matching factors, we matched 236 controls for these SSI cases, and the subsequent statistical analysis was performed on these 354 patients. After adjusting for confounding factors, the results indicated that the risk of SSI was 70% higher in the group receiving SAP 31 to 60 minutes before
incision compared to the group receiving SAP 0 to 30 minutes before
incision (OR=1.732, 95%CI 1.031-2.910, p=.038). Additionally, the risk of SSI was 150% higher in the group receiving SAP 61 to 120 minutes before
incision compared to the group receiving SAP 0 to 30 minutes before
incision (OR=2.532, 95%CI 1.250-5.128, p=.010). In subgroup analysis, this statistical trend persisted for both deformity surgeries and different SSI classifications.
CONCLUSIONS: Administering cefuroxime SAP within 30 minutes before skin
incision significantly reduces the risk of SSI, whether they are deep or superficial, in spinal fusion surgery. This pattern remains consistent among spinal deformity patients.