NNIS评分在首次髋膝关节置换术及髋膝关节翻修术手术部位感染预测的应用

Application of NNIS scores in predicting surgical site infection in the first and revision hip and knee joint arthroplasty

目的探索NNIS评分系统在预测首次及翻修的髋膝关节置换术发生手术部位感染的差别。方法回顾性分析广东省某三甲医院2014年6月~2019年6月开展的1309例髋膝关节置换术病例,采用Logistic回归比较首次手术组和翻修手术组发生感染的风险,并进一步探讨NNIS评分分层分析。结果髋膝关节置换术手术部位感染率为1.83%,其中翻修手术组感染率为13.43%、首次手术组感染率为1.21%(OR=12.683);翻修手术组的手术时长、NNIS评分、术后住院和用药天数均大于首次手术组(P<0.05)。以NNIS评分分层分析,高评分组发生手术部位感染的危险度是低评分组的5.3倍;进一步以首次和翻修分组,发现手术部位感染率NNIS评分为1的组,差异有统计学意义(P=0.000)。多元Logistic回归分析控制年龄、性别和NNIS评分后,翻修手术感染率的危险度仍然达到首次手术的10倍以上。结论未区分翻修手术和首次手术会导致髋膝关节置换术的手术部位感染率被高估,NNIS评分难以预测该差异。

Objective To investigate the difference of NNIS scoring system in predicting surgical site infection(SSI)in the first and revision hip and knee joint arthroplasty.Methods A total of 1309 cases of hip and knee joint arthroplasty performed in a grade 3 and first-class hospital of Guangdong Province from June 2014 to June 2019 were retrospectively analyzed,and logistic regression was used to compare the infection risk between the first arthroplasty group and the revision arthroplasty group,and the NNIS stratified analysis was further explored.Results The SSI rate of hip and knee joint arthroplasty was 1.83%,among which that of the revision arthroplasty group was 13.43%and that of the first arthroplasty group was 1.21%(OR=12.683);the operation duration,the NNIS scores,the postoperative hospitalization and medication days of the revision arthroplasty group were all more than those of the first arthroplasty group(P<0.05).According to stratified analysis of NNIS scores,the risk of SSI in the high score group was 5.3 times that in the low score group;furthermore,according to the first and revision grouping method,the SSI rate was found to be statistically different in the group with NNIS score of 1(P=0.000).Multivariate logistic regression analysis,revealed that after controlling age,sex and NNIS scores,the risk of infection rate of the revision arthroplasty was still 10 times more than that of the first hip and knee joint arthroplasty.Conclusion Failure to distinguish between revision arthroplasty and first arthroplasty will lead to an overestimation of SSI rate of hip and knee joint arthroplasty,which is difficult to predict by NNIS risk index.