初次后路腰椎间融合早期手术部位感染的相关因素△

Factors related to early surgical site infection in primary posterior lumbar interbody fusion

摘要:

[目的]探讨初次后路腰椎间融合术（posterior lumbar interbody fusion, PLIF）术后早期手术部位感染（surgical site in- fection, SSI） 的相关因素。[方法] 本院 2019 年 1 月—2022 年 1 月行 PLIF 术患者 468 例纳入本研究，观察术后 SSI 的发生情况，采用单因素比较和多元逻辑回归分析探索 SSI 发生的相关因素。[结果]468 例患者中 18 例发生 SSI，占比 3.9%。感染组患者女性占比 [男/女, (5/13) vs (232/218), P=0.048]、年龄 [(59.7±7.2) 岁 vs (56.3±8.5) 岁, P=0.012]、术前合并糖尿病 [无/轻/中/重, (13/2/ 2/1) vs (408/19/15/8), P=0.012] 及尿路感染 [无/轻/中/重, (14/2/1/1) vs (423/23/2/2), P=0.005]、手术时间 [(206.3±15.7) min vs (181.2± 12.1) min, P＜0.001]、术后引流量 [(330.2±53.5) ml vs (292.3±48.6) ml, P＜0.001] 及引流时间 [(2.4±0.5) d vs (2.0±0.4) d, P＜0.001] 显著高于未感染组；而感染组患者术前血红蛋白 [(135.2±7.4) g/L vs (139.6±8.6) g/L, P=0.008] 及白蛋白 [(36.0±3.1) g/L vs (40.4±3.10) g/L, P= 0.019] 显著低于未感染组。多因素逻辑回归分析显示，术前合并糖尿病 （OR=1.898, P=0.011），合并尿路感染 （OR=1.612, P= 0.027），引流时间长 （OR=1.426, P=0.015） 是术后早期 SSI 的危险因素；而男性 （OR=0.811, P=0.038） 和白蛋白水平高 （OR= 0.676, P=0.002）是 SSI 的保护因素。[结论] 女性、术前合并糖尿病、合并尿路感染、低蛋白血症及引流时间延长是腰椎后路内固定术后早期 SSI 危险因素。

Abstract:

[Objective] To investigate the factors related to early surgical site infection (SSI) after posterior lumbar interbody fusion (PLIF). [Methods] A total of 468 patients who underwent PLIF surgery in our hospital from January 2019 to January 2022 were included in this study. The occurrence of postoperative SSI was observed, and the related factors of SSI were explored by univariate comparison and multiple logistic regression analysis. [Results] The SSI occurred in 18 of 468 patients, accounted for 3.9%. The infection group proved significantly greater than the non-infection group in terms of women proportion [male/female, (5/13) vs (232/218), P=0.048], age [(59.7±7.2) years vs (56.3±8.5) years, P=0.012], preoperative diabetes mellitus [no/mild/medium/severe, (13/2/2/1) vs (408/19/15/8), P=0.012] and urinary tract infections [no/mild/medium/severe, (14/2/1/1) vs (423/23/2/2), P=0.005], operation time [(206.3±15.7) min vs (181.2±12.1) min, P＜ 0.001], postoperative drainage volume [(330.2±53.5) ml vs (292.3±48.6) ml, P＜0.001] and drainage time [(2.4±0.5) days vs (2.0±0.4) days, P＜ 0.001], whereas the former was significantly lower than the latter regarding the preoperative hemoglobin [(135.2±7.4) g/L vs (139.6±8.6) g/L, P=0.008] and albumin [(36.0±3.1) g/L vs (40.4±3.10) g/L, P=0.019]. As results of multivariate logistic regression analysis, the preoperative diabetes mellitus (OR=1.898, P=0.011), urinary tract infection (OR=1.612, P=0.027), and long drainage time (OR=1.426, P=0.015) were risk factors for early postoperative SSI, while the males (OR=0.811, P=0.038) and high albumin levels (OR=0.676, P=0.002) were protective factors for SSI. [Conclusion] Female, preoperative diabetes, urinary tract infection, hypoproteinemia and prolonged drainage time are risk factors for early SSI after posterior lumbar interbody fusion.