1629例膝关节置换术信息化目标监测结果与假体周围感染的直接经济学负担分析

Analysis of the direct economic burden of informational targeted monitoring results and periprosthetic joint infection in 1629 cases of the knee arthroplasty

目的探讨膝关节置换手术部位感染(SSI)发生情况、有效的监测方法和直接经济学负担,为制定膝关节置换SSI监测和预防措施提供理论依据。方法对2018年1月-2019年12月初次行膝关节置换手术患者实施SSI信息化目标性监测,术后1年进行电话随访,对监测资料进行分析,获得膝关节置换SSI情况并评估信息化监测的有效性,同时进行1∶2条件配对后,选出未感染组,分析治疗假体周围感染(PJI)的直接经济学负担。结果电话随访成功的膝关节置换手术患者1629例,术后1年内发生SSI 27例,SSI发生率为1.66%;其中PJI 14例(占比51.85%),表浅切口感染8例(占比29.63%),深部切口感染5例(占比18.52%)。术后30 d内SSI 16例(占总SSI 59.26%),术后90 d内SSI 25例(占总SSI 92.59%)。信息化方法共监测SSI 21例(1.29%),总SSI监测有效率为77.78%,对PJI的监测有效率为100.00%。PJI组较未感染组增加的住院日和总费用分别是43.98 d和122230.18元(P<0.001),其中材料费、药费、检查检验费、手术费、护理费等各项费用均增加(P<0.05)。结论信息化可以有效监测膝关节置换手术SSI,术后90 d内SSI是监测的重点,PJI直接经济负担很重,应引起膝关节置换手术SSI感染预防的高度重视。

OBJECTIVE To explore the occurrence,effective monitoring methods and direct economic burden of surgical site infection(SSI)in knee arthroplasty,so as to provide a theoretical basis for formulating SSI monitoring and preventive measures in knee arthroplasty.METHODS From Jan 2018 to Dec 2019,patients who underwent knee arthroplasty for the first time were subject to SSI targeted monitoring.One year after surgery,they were followed up by telephone.The monitoring data were analyzed to obtain the condition of SSI after knee arthroplasty and evaluate the effectiveness of informational targeted monitoring.At the same time,the direct economic burden of treating periprosthetic joint infection(PJI)was analyzed the no infection group was screened out after 1∶2 propensity score matching.RESULTS In 1629 knee arthroplasty patients successfully followed up by telephone,27 patients developed SSI within one year after operation,with the incidence of SSI of 1.66%.14 cases had PJI(51.85%),8 cases had superficial incision infection(29.63%),and 5 cases had deep incision infection(18.52%).Within 30 days after operation,16 cases occurred SSI(accounting for 59.26%of the total SSI),and there were 25 cases of SSI within 90 days after operation(accounting for 92.59%of the total SSI).A total of 21 cases of SSI were monitored by informational method(1.29%).The total effective rate of SSI monitoring was 77.78%,and the effective rate of PJI monitoring was 100.00%.Compared with the uninfected group,the increased hospitalization days in the PJI group were 43.98 days and increased total expenses were 122230.18 yuan(P<0.001),including significant increase of the cost of materials,medicine,examination and inspection,surgery,nursing and other expenses(P<0.05).CONCLUSION Informational targeted monitoring can effectively monitor SSI in the patients undergoing knee arthroplasty.SSI within 90 days after operation is the focus of monitoring.PJI has a heavy direct economic burden,which should be paid great attention to the prevention of SSI infection in knee arthroplasty.