基于logistic回归模型分析骨科手术部位感染的影响因素

Analysis of influencing factors of orthopedic surgical site infection based on logistic regression model

目的总结骨科手术部位感染现状,探讨骨科手术部位感染的影响因素。方法收集江苏省盐城市第三人民医院2022年1月至2023年12月骨科手术部位感染病例作为感染组,共41例,按照1∶1的比例,随机抽取同科室2022年1月至2023年12月年龄相近(±10岁)、性别相同未发生手术部位感染的41例病例作为非感染组,分析骨科手术部位感染病原菌分布情况并基于二分类logistic回归模型分析骨科手术部位感染的影响因素。结果本研究共纳入41例手术部位感染患者,术后1~3 d发生手术部位感染10例(24.39%),术后4~6 d发生手术部位感染12例(29.27%),术后7~9 d发生手术部位感染5例(12.20%),术后10~30 d发生手术部位感染10例(24.39%),术后31~90 d发生手术部位感染4例(9.76%)。感染组检出40株病原菌,主要为革兰氏阳性球菌(31株,77.50%),最常见的为金黄色葡萄球菌(19株,47.50%),其次为凝固酶阴性葡萄球菌(7株,17.50%)。两组糖尿病史、体重指数(BMI)、术前纤维蛋白原、手术持续时间、手术引流比较,差异有统计学意义(P<0.05)。logistic回归分析显示,患者BMI(OR=1.231,95%CI:1.049~1.445,P=0.011)是骨科手术部位感染的独立危险因素。BMI作为手术部位感染的独立危险因素,其临界值为25.37 kg/m2。结论骨科手术患者中,肥胖患者更易发生手术部位感染,建议进一步强化肥胖患者的围手术期管理,以减少手术部位感染的发生。

Objective To summarize the current situation of orthopedic surgical site infection and to explore the influencing factors of orthopedic surgical site infection.Methods A total of 41 cases of orthopedic surgical site infection in Yancheng Third People’s Hospital,Jiangsu Province from January 2022 to December 2023 were collected as the infection group,according to the ratio of 1:1,41 cases with similar age(±10 years old)and the same gender without surgical site infection in the same department from January 2022 to December 2023 were randomly selected as the non-infected group.The distribution of pathogenic bacteria in orthopedic surgical site infection was analyzed and the influencing factors of orthopedic surgical site infection were analyzed based on the binary logistic regression model.Results A total of 41 patients with surgical site infection were included in this study,of which 10 patients(24.39%)developed surgical site infection from one to three days after surgery,12 patients(29.27%)developed surgical site infection from four to six days after surgery,and 5 patients(12.20%)developed surgical site infection from seven to nine days after surgery,10 patients(24.39%)developed surgical site infection from ten to 30 days after surgery,and 4 patients(9.76%)developed surgical site infection from 31 to 90 days after surgery.A total of 40 strains of pathogenic bacteria were detected in the infection group,mainly Gram positive coccus(31 strains,77.50%),the most common Staphylococcus aureus(19 strains,47.50%),followed by Coagulase-negative staphylococcus(seven strains,17.50%).There were significant differences in diabetes history,body mass index(BMI),preoperative fibrinogen,operation duration,and surgical drainage between the two groups(P<0.05).Logistic regression analysis showed that BMI(OR=1.231,95%CI:1.049-1.445,P=0.011)was an independent risk factor for orthopedic surgical site infection.BMI was an independent risk factor for surgical site infection with a cutoff of 25.37 kg/m2.Conclusion Among orthopedic surgery patients,obese patients are more prone to surgical site infection.It is suggested to further strengthen perioperative management of obese patients to reduce the incidence of surgical site infection.