Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and November 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms. Eighteen (90%) of the patients had deep infections; nine required removal of the prosthesis. A single surgeon (surgeon X) was associated with 18 of the procedures that had subsequent infection (risk ratio (RR) = 9.4, 95% confidence interval (CI) 2.2-39), and an investigation was carried out in an effort to explain the difference in infection rates between surgeon X and other surgeons. In a cohort study, stratified analyses identified a preoperative American Society of Anesthesiologists (ASA) physical status class greater than or equal to 3, surgeon X, and early postoperative use of a continuous passive motion device as risk factors associated with surgical wound infection following total knee arthroplasty procedures. Logistic regression analyses identified being a patient operated on by surgeon X with an ASA class greater than or equal to 3 as the only significant independent risk factor for total knee arthroplasty-associated surgical wound infections (RR = 9.3, 95% CI 2.8-31). The effect due to surgeon X could not be explained by receipt or timeliness of administration of antimicrobial prophylaxis, type of prosthesis inserted, duration of operation, postoperative use of continuous passive motion, or underlying etiology of joint disease. The authors conclude that surgical technique and patient's severity of illness were the primary determinants of surgical wound infection after total knee arthroplasty. This study demonstrates the complexity of epidemiologic investigation of surgical wound infections and the importance of considering patient severity of illness when interpreting surgeon-specific infection rates.

译文

:伤口感染是全膝关节置换术的一种罕见但严重的并发症。在1984年1月至1987年11月之间,两家附属医院的243名患者中有20名(8.2%)在清洁空气手术室中进行了259次全膝关节置换手术后出现了手术伤口感染。 18名(90%)患者患有深部感染;九个需要去除假体。一名外科医生(外科医生X)与18例随后感染的手术相关联(风险比(RR)= 9.4,95%置信区间(CI)2.2-39),并进行了调查以解释X外科医师和其他外科医师之间的感染率差异。在一项队列研究中,分层分析确定术前美国麻醉医师协会(ASA)身体状况等级大于或等于3,X医师和术后早期使用连续被动运动装置是与总手术后伤口感染相关的危险因素。膝关节置换术。 Logistic回归分析确定是由ASA级大于或等于3的X外科医师手术的患者,是全膝关节置换相关手术伤口感染的唯一重要独立危险因素(RR = 9.3,95%CI 2.8-31) 。不能通过接受抗生素预防措施的及时性,插入的假体的类型,手术的持续时间,术后持续使用被动运动或关节病的病因来解释外科医生X的影响。作者得出结论,手术技术和患者疾病的严重程度是全膝关节置换术后手术伤口感染的主要决定因素。这项研究证明了外科伤口感染的流行病学调查的复杂性,以及在解释外科医生特定感染率时考虑患者疾病严重性的重要性。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录