腰椎后路手术部位感染相关因素的Meta分析

Meta-analysis of risk factors of the surgical site infection through lumbar posterior approach

背景:手术部位感染是腰椎后路手术后的主要并发症,不但增加了患者的住院时间、经济负担和身体上的痛苦,也给临床医护人员开展工作增加了困难,还影响术后康复,甚至导致死亡。因而,有必要对国内可能引起腰椎后路术后发生手术部位感染的相关因素进行分析。目的:探讨国内腰椎术后手术部位感染发生的相关影响因素。方法:计算机全面检索国内关于腰椎后路术后发生手术部位感染的相关研究,通过阅读全文对文献进行方法学质量评价,运用Rev Man 5.3软件进行异质性分析,再进行Meta分析合并效应量。结果与结论:(1)共计纳入20个研究,其中术后发生手术部位感染组患者423例,对照组13 995例;(2)Meta分析单因素分析结果:体质量指数≥27 kg/m2[OR=3.82,95%CI(2.47,5.91),P<0.000 01]、年龄≥60岁[OR=1.99,95%CI(1.44,2.76),P<0.000 1]、术中出血量≥300 m L[OR=3.98,95%CI(2.50,6.33),P<0.000 01]、皮下脂肪厚度[MD=5.35,95%CI(3.58,7.12),P<0.000 01]、手术节段≥3[OR=3.83,95%CI(2.02,7.26),P<0.000 1]、手术时间≥180 min[OR=2.96,95%CI(2.06,4.27),P<0.000 01]、术前血清蛋白<35 g/L[OR=2.37,95%CI(1.63,3.46),P<0.000 01]、糖尿病[OR=2.88,95%CI(2.22,3.74),P<0.000 01]均是腰椎后路术后发生手术部位感染的危险因素;(3)多因素分析显示:体质量指数≥27 kg/m2[OR=3.21,95%CI(1.97,5.22),P<0.000 01]、皮下脂肪厚度[MD=5.35,95%CI(3.58,7.12),P<0.000 01]、术前血清蛋白<35 g/L[OR=3.73,95%CI(2.30,6.04),P<0.000 01]、糖尿病[OR=3.35,95%CI(1.75,6.42),P=0.003]均为腰椎后路术后发生手术部位感染的独立危险因素;(4)提示体质量指数≥27 kg/m2、皮下脂肪厚度、术前血清蛋白<35 g/L、糖尿病均为国内腰椎后路术后发生手术部位感染的独立危险因素;受到研究中发生手术部位感染病例数和其方法学质量的影响,上述结论仍需进行更多大样本、高质量研究来证实,从而为围手术期的管理提供可靠证据。

BACKGROUND： Surgical site infection is the main complication after posterior lumbar surgery, which not only increases the patient＇s hospitalization time, financial burden and physical pain, but also increases the difficulty for the clinical medical staff, delays the recovery of postoperative patients, even leads to deaths. Therefore, it is important to analyze the factors related to the infection of the surgical site after posterior lumbar surgery. OBJECTIVE： To analyze the risk factors of the surgical site infection after lumbar posterior approach in China. METHODS： Studies about the surgical site infection after lumbar posterior approach were retrieved by computer. The quality of the studies was evaluated by reading the full text. Heterogeneity was analyzed using RevMan 5.3 software. Meta analysis was used to analyze the combined effect. RESULTS AND CONCLUSION： （1） Totally 20 studies with 423 cases of surgical site infection and 13 995 cases of non-infection were included. （2）Meta-analysis univariate analysis results：body mass index ≥ 27 kg/m^2[OR=3.82,95%CI（2.47,5.91）,P〈0.000 01],age ≥ 60 years [OR=1.99,95%CI（1.44,2.76）,P〈0.000 1],intraoperative blood loss ≥ 300 mL[OR=3.98,95%CI（2.50,6.33）,P〈0.000 01],subcutaneous fat thickness[MD=5.35,95%CI（3.58,7.12）,P〈0.000 01],number of segments ≥ 3[OR=3.83,95%CI（2.02,7.26）,P〈0.000 1],operation time ≥180 minutes[OR=2.96,95%CI（2.06,4.27）,P〈0.000 01],preoperative serum protein〈35 g/L[OR=2.37,95%CI（1.63,3.46）,P〈0.000 01],and diabetes[OR=2.88,95%CI（2.22,3.74）,P〈0.000 01]were risk factors for surgical site infection after lumbar posterior approach.（3）Multivariate analysis results：body mass index ≥ 27 kg/m^2[OR=3.21,95%CI（1.97,5.22）,P〈0.000 01],subcutaneous fat thickness[MD=5.35,95%CI（3.58, 7.12）,P〈0.000 01],preoperative serum protein〈35 g/L[OR=3.73,95%CI（2.30,6.04）,P〈0.000 01],and diabetes[OR=3.35,95%CI（1.75,6.42）, P=0.003]were independent risk factors for surgical site infection after lumbar posterior surgery.（4）Results showed that body mass index ≥27 kg/m^2, subcutaneous fat thickness, preoperative serum protein 〈 35 g/L, and diabetes are independent risk factors for surgical site infection after lumbar posterior approach in China. Due to the number of cases of surgical site infection and its methodological quality during the study, the above conclusions still need to be confirmed by more large-scale, high-quality studies to provide reliable evidence for perioperative management.