腰椎滑脱症术后伤口感染危险因素分析

目的：探讨腰椎滑脱症术后伤口感染发生的相关危险因素。方法：对2013年1月至2017年12月因腰椎滑脱症行后路减压融合内固定术的296例患者进行回顾性分析,根据术后伤口是否感染分为感染组29例,男13例,女16例,平均年龄（67.03±1.01）岁;非感染组267例,男91例,女176例,平均年龄（52.32±16.08）岁。记录两组患者的性别、年龄、肥胖体重指数（BMI）、吸烟史、糖尿病史、激素药物使用史、白蛋白水平、手术时间、美国麻醉医师协会评分（ASA评分）、围手术期输血、引流管时间等,对单因素Logistic回归分析有统计学意义的危险因素进行多元Logistic回归分析,同时采用SPSS决策树模型确定连续性变量的分层界点,进一步明确独立危险因素。结果：296例患者中术后共有29例发生手术切口感染,发生率约9.8%（29/296）。感染组与非感染组在BMI、年龄、糖尿病史、引流管时间、激素药物使用史、白蛋白水平、手术时间差异有统计学意义（P<0.05）;单因素Logistic回归分析排除各因素间的相互影响后结果显示：肥胖、年龄、糖尿病史、激素药物使用史、手术时间、引流管时间可能为腰椎滑脱症术后伤口感染的危险因素,将上述可能的危险因素纳入多因素Logistic回归分析显示：年龄、糖尿病史、激素药物使用史、引流管时间是术后伤口感染的独立危险因素。结论：年龄、糖尿病史、激素药物使用史、引流管时间是术后伤口感染的独立危险因素,年龄≥64岁、引流管留置时间超过48 h、合并糖尿病、激素药物使用是术后发生伤口感染的高危因素。     

Association between anemia and postoperative complications in infants undergoing pyloromyotomy

BackgroundAlthough preoperative anemia has been suggested to predict postsurgical morbidity and mortality among infants < 1 year of age, the data were drawn from heterogeneous patient cohorts including severely ill infants undergoing complex, high-risk procedures. We aimed to determine whether untreated preoperative anemia was associated with increased risk of postoperative complications in infants < 1 year of age who underwent pyloromyotomy, a common and relatively simple surgery.MethodsInfants < 1 year of age undergoing pyloromyotomy were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric database. Preoperative anemia was defined as a hematocrit ≤ 40% for infants 0–30 days of age and ≤ 30% for infants more than 30 days of age. Patients who received pre- or postoperative blood transfusions were excluded.ResultsWe identified 2948 patients who met our inclusion criteria, of whom 843 were anemic (29%). The overall rate of complications in this cohort was 6%. The most common postoperative complications were readmission (97 cases), surgical site infection (43), reoperation (39), prolonged hospital stay (24), urinary tract infection (3), 30-day mortality (3) and cardiac arrest (2). We found no differences in the incidence of complications in anemic versus nonanemic patients on bivariate analysis or multivariable logistic regression (adjusted odds ratio = 1.2; 95% confidence interval: 0.8–1.7; P = 0.319).ConclusionsIn relatively healthy infants undergoing pyloromyotomy, untreated preoperative anemia was not associated with postoperative compilations and should not be considered a significant risk factor.Level of evidence III.     

Prospective Identification of Risk Factors for Wound Infection After Lower Extremity Oncologic Surgery

Background: Surgical site infections (SSI) are frequent causes of morbidity and mortality after orthopaedic oncologic procedures. This study was conducted to identify the surgical site infection rate following a lower extremity or pelvic procedure and assess the risk factors for acquiring SSI by direct observation of orthopaedic oncology patients wounds at a comprehensive cancer center.Methods: One hundred ten consecutive patients were prospectively studied. The surveillance of surgical site infections was carried out by a surgeon-trained nurse from the Infectious Disease Service. Nineteen variables were analyzed as risk factors.Results: The overall SSI rate was 13.6% (15 of 110). Excluding those patients with known preoperative infections, the SSI rate was 9.5% (10 of 105). Two statistically significant risk factors for surgical site infection in these patients emerged in the multivariate analysis: blood transfusion (P = .007) and obesity (P = .016). Procedure category was significant in univariate analysis only. Preoperative length of stay, length of procedure, prior adjuvant treatment (chemotherapy or radiotherapy), prior surgery, and use of an implant or allograft were not statistically significant risk factors for wound infection. Antibiotic usage patterns did not influence SSI rate.Conclusions: Blood transfusion and obesity should be considered individual risk factors for the development of wound infection in patients having orthopaedic oncologic procedures.     

Perioperative allogenic blood transfusions are associated with increased fracture related infection rates,but not nonunion in operatively treated distal femur fractures

IntroductionDistal femur fractures are common injuries that remain difficult for orthopedic surgeons to treat. High complication rates, including nonunion rates as high as 24% and infection rates of 8%, can lead to increased morbidity for these patients. Allogenic blood transfusions have previously been identified as risk factors for infection in total joint arthroplasty and spinal fusion surgeries. No studies have explored the relationship between blood transfusions and fracture related infection (FRI) or nonunion in distal femur fractures.Methods418 patients with operatively treated distal femur fractures at two level I trauma centers were retrospectively reviewed. Patient demographics were collected including age, gender, BMI, medical comorbidities, and smoking. Injury and treatment information was also collected including open fracture, polytrauma status, implant, perioperative transfusions, FRI, and nonunion. Patients with less than three months of follow up were excluded.Results366 patients were included in final analysis. One hundred thirty-nine (38%) patients received a perioperative blood transfusion. Forty-seven (13%) nonunions and 30 (8%) FRI were identified. Allogenic blood transfusion was not associated with nonunion (13% vs 12%, P = 0.87), but was associated with FRI (15% vs 4%, P<0.001). Binary logistic regression analysis identified a dose dependent relationship between number of perioperative blood transfusions and FRI: total transfusion ≥2 U PRBC RR= 3.47(1.29, 8.10, P = 0.02), ≥3 RR= 6.99 (3.01, 12.40, P<0.001), and ≥4 RR= 8.94 (4.03, 14.42, P<0.001).DiscussionIn patients undergoing operative treatment of distal femur fractures, perioperative blood transfusions are associated with increased risk of fracture related infection, but not the development of a nonunion. This risk association increases in a dose-dependent relationship with increasing total blood transfusions received.     

Risk factors for infection after operative fixation of Tibial plateau fractures

IntroductionTibial plateau fractures are challenging to treat due to the high incidence of postoperative infections. Treating physicians should be aware of risk factors for postoperative infection in patients who undergo operative fixation.Patients and methodsA retrospective review was undertaken to identify all patients with tibial plateau fractures over a 10 year period (2003–2012) who underwent open reduction internal fixation. A total of 532 patients were identified who met the inclusion criteria. Several patient and clinical characteristics were recorded, and those variables with a significant association (p < 0.05) with postoperative infection after a univariate analysis were further analyzed using a multivariate analysis.ResultsFifty-nine (11.1%) of the 532 patients developed a deep infection. The average length of follow-up for patients was 19.5 months. Methicillin-resistant Staphylococcus aureus was the most common species, and it was isolated in 26 (44.1%) patients. Open fractures, the presence of compartment syndrome, and a Schatzker type IV−VI were found to be independent risk factors for deep infection.ConclusionsThe rate of deep infection remains high after operative fixation of tibial plateau fractures. Patients with risk factors for infection should be counseled on the possibility of reoperation, and surgeons should consider MRSA prophylaxis in those patients who are at higher risk.     

Infections nosocomiales dans un service de brûlés. Résultats d'une enquête prospective d'un an

ObjectivesTo assess nosocomial infections in a burn care centre, to identify patients' infection risk factors at the time of admission and factors of monthly variations of infection incidence.Study designProspective survey, from October 1992 to September 1993.Patients and methodThe study included 140 patients staying for more than two days in a 22-bed burn unit. Nosocomial infection criteria were derived from the 1988 CDC critera. Incidence rates of infection were calculated. Infected and noninfected patients were compared. Each monthly infection incidence was compared with six unit activity indicators.ResultsFifty-six patients developed 132 infections. The overall incidence was 94%. Incidence density was 25 infections per 1,000 days of care. The distribution of infected sites was: skin (30%), intravascular catheters (25%), blood (22%), urinary tract (18%), respiratory tract (5%). The most frequent pathogens were Pseudomonas sp (49%), Staphylococcus sp (18%), Escherichia coli (18%), and Streptococcus faecalis (10%). They were characterized by a good antibiotic sensitivity. Each common burn severity index was predictive of nosocomial infections. Facial, perineal and respiratory lesions were also linked to infection. There was a positive correlation between the peak of nosocomial infections in the unit during a month and the peak of activity during the foregoing one.ConclusionIncidence rates of infection were high, as 40% of the population was concerned. Choosing reliable infection criteria was the most difficult problem to solve.     

La glomérulonéphrite aiguë post-streptococcique de l’enfant dans le sud tunisien : étude rétrospective de 12 ans

AimPost-streptococcal glomerulonephritis (PSGN) is a frequent cause of acute nephritis in children. This study aimed to describe the epidemiology, clinical characteristics and outcomes of PSGN and look for predictor's factors of severity.MethodsA 12-year retrospective review of case notes and laboratory data was conducted at a department of pediatrics, pediatric emergency and intensive care, Hedi Chaker Hospital.ResultsOne hundred seventy eight children were treated for PSGN with a mean age of 7.6 ans ± 3.43 ans. One hundred and forty-two patients (80%) had a history of a recent upper respiratory tract or skin infection. Streptococcal pharyngitis was the most common cause, identified in 113 patients (67.6%). Macroscopic hematuria and edema were noted in 135 (75.8%) and 114 cases (64%) respectively. Hypertension was present in 55 patients (31%). Oliguria was noted in 30 children (16.8%). Sixty-six subjects (37%) developed acute renal impairment (creatinine ≥ 70 micromoles/L). No correlation was demonstrated between acute renal impairment and age, sex, triggering infection, anemia and white blood cell count. Creatinine greater than 56.35 micromoles/L was associated with a high risk of developing high blood pressure. The mean length of admission was 5.8 days ± 4.44. Only one subject has ongoing renal dysfunction.ConclusionPSGN remains a common nephropathy in our region. The detection and effective treatment of any infection that may be involved can reduce the incidence of this disease.     

Neurogenic Bowel Management in Adults with Spinal Cord Injury

Abstract

Background: Individuals with spinal cord injury (SCI) have a lifelong increased risk of systemic infection, which may be associated with episodes of life-threatening bacteremia. Information concerning specific organisms causing bacteremia, the sites of primary infection, and clinical predictors for mortality are necessary to provide optimal treatment.

Methods: A retrospective review of positive blood cultures collected over a 3 2-month period in chronic SCI patients treated at the Veterans Affairs Medical Center SCI Unit.

Results: One hundred and twenty-three episodes of bacteremia occurred in 63 patients during 83 hospitalizations; 30 patients had multiple episodes of bacteremia. There were 1 ,644 admissions during this period, yielding an incidence of bacteremia of 7 .5% (5.8% after excluding positive cultures that were believed to be caused by contaminants). The patients (31 with paraplegia and 32 with quadriplegia) had a mean age of 59 ± 2 years, and a mean duration of injury of 23 ± 2 years. Bladder management technique consisted of indwelling bladder catheter (n = 53), ileal conduit (n = 6), intermittent catheterization (n = 2), and spontaneous voiding (n = 2). Episodes of bacteremia were nosocomial in 89 out of 123 episodes. Multiple debilitating factors were present, including pressure ulcers in 3 6 out of 63 patients, chronic ventilator dependency in 5 out of 63 patients, recent surgical procedures in 17 out of 63 patients, unde rlying malignancy in 5 out of 63 patients, and evidence of malnutrition in 2 9 out of 63 patients (serum albumin concentration < 2.5 g/dl). Early mortality rate (death within 30 days of bacteremia) occurred in 8 out of 63 patients (13 %) and late mortality (> 1 month following a bacteremic episode) occurred in 1 0 additional participants, such that total mortality was 1 8 out of 63 (2 9%). The sources of bacteremia were urinary tract infection (n = 3 9), presumed contaminant (n = 28), decubitus ulcers (n = 21 ), intravascular catheter (n = 1 9), pneumonia (n = 5), and other (n = 11 ). Gram-negative rods accounted for 2 6 out of 3 9 episodes of bacteremia from a urinary source. Methicillin-resistant Staphylococcus au reus, methicillin-sensitiveS au reus, and coagulase-negative staphylococci were the predominant organi sms when intravascular catheters or pressure ulce rs were the source of bacteremia.

Conclusion: In this population, bacteremia predominantly was caused by hospital-associated organisms, and occurred mainly in malnourished patients who required hospitalization for major unde rlying debilitating conditions, particularly pressure ulcers. Chronic indwelling bladder cathet e rs and chronic vascular catheter usage also were highly prevalent in patients with bacteremic episodes. Hypoalbuminemia was the strongest independent predictor for mortality.     

High Rate of Re-Revision in Patients Less Than 55 Years of Age Undergoing Aseptic Revision Total Knee Arthroplasty

BackgroundThere are limited data on the outcomes of revision total knee arthroplasty in young patients. We sought to characterize the re-revision-free survival and risk factors for re-revision in patients less than 55 years who underwent aseptic revision TKA.MethodsWe retrospectively reviewed 197 revision TKAs at a mean follow-up of 5 years. Mean age was 49 years; mean body mass index was 31 kg/m². Twenty-seven (14%) patients had at least 1 prior revision TKA. The most common indications for revision included instability (29%), arthrofibrosis (26%), and aseptic loosening (24%). Constraint included the following: 59 posterior-stabilized (30%), 123 varus-valgus constrained (62%), and 15 hinged (8%). Components revised included the following: 93 femur/tibia (47%), 68 polyethylene-only (35%), 19 femur-only (10%), and 17 other (9%). Survivorship free from re-revision was calculated via the Kaplan-Meier method and a multivariate Cox proportional regression was utilized to identify risk factors for re-revision.ResultsSurvivorship free from any re-revision at 5 years was 80%. In the multivariate analysis, patients with a prior revision (hazard ratio [HR] = 2.78, P = .02), an isolated polyethylene exchange (HR = 3.0, P = .004), and a hinged prosthesis (HR = 3.47, P = .05) were significant risk factors for lower revision-free survival. Forty-two patients (21%) underwent re-revision, most commonly for periprosthetic joint infection (7%), instability (6%), and aseptic loosening (5%). Re-revision occurred in 18/68 (26%) patients undergoing an isolated polyethylene exchange.ConclusionPatients less than 55 years undergoing revision TKA have a modest 5-year revision-free survival of 80%. Patients with prior revision TKAs (HR = 2.78), hinge type prostheses (HR = 3.47), and polyethylene-only revisions (HR = 3.0) had higher revision rates.     

Access-related complications in anterior lumbar surgery in patients over 60 years of age

Purpose

The anterior approach is widely used for access to the lumbar spine in the setting of adult deformity either as a stand-alone procedure or in combined anterior–posterior procedures. Access-related complication rates have so far not been reported in an elderly patient population, in which it has been suggested that anterior lumbar surgery is indicated with caution. Here, the complication rates in patients over 60 years of age are reported.

Methods

A retrospective chart review in a consecutive series of 31 patients over 60 years of age and in which a retroperitoneal access to the lumbar spine was performed. All charts including anaesthetic charts were reviewed and the patients’ demographics, exact surgical procedure, comorbidities, and potential risk factors, as well as intraoperative and vascular complications noted. Patients who had revision anterior surgery, anterior surgery for tumour resection, trauma or infection were excluded.

Results

The average age of patients was 64.9 years, ranging 60–81. Eighteen patients were female and 13 male. The average body mass index was 26.7 ranging 18.5–44.0. The indications for surgery were degenerative scoliosis (12 patients), degenerative spondylosis (7 patients), degenerative spondylolisthesis (5 patients), iatrogenic spondylolisthesis following prior posterior decompression (5 patients), and pseudarthrosis following posterolateral instrumented fusion (2 patients). In 10 patients, a single-level anterior lumbar interbody fusion (ALIF) was carried out (1 L3/4, 5 L4/5, 4 L5/S1) and in 11 patients ALIF was performed on two levels (1 L2–4, 1 L3–5, 9 L4–S1). In three patients, 3 levels from L3 to S1 were approached and in seven patients 4 levels from L2 to S1. Patients with three- and four-level anterior lumbar surgery had higher blood loss than two- and one-level surgery (616 ± 340 vs 439 ± 238, p = 0.036). The overall complication rate was 29 % (9/31), which included four vascular injuries and one pulmonary embolism. The vascular complication rate was 13 % (4/31) with two arterial and two venous injuries requiring repair. No major blood loss over 2,000 ml occurred.

Conclusions

Anterior lumbar surgery in an elderly population does not necessarily have higher overall complication rates than in a younger population. The risk of vascular injury requiring repair was higher, but has not resulted in major blood loss and the procedure therefore can be carried out safely. The overall complication rate and blood loss compare favourably to complication rates in posterior adult deformity procedures.

     

Ductal carcinoma in situ diagnosed by breast needle biopsy: Predictors of invasion in the excision specimen

BackgroundA substantial proportion of women with a pre-operative diagnosis of pure ductal carcinoma in situ (DCIS) has a final diagnosis of invasive breast cancer (IBC) after surgical excision and, consequently, a potential indication for lymph node staging. The aim of our study was to identify novel predictors of invasion in patients with a needle-biopsy diagnosis of DCIS that would help us to select patients that may benefit from a sentinel node biopsy (SNB).Patients and MethodsWe included 153 patients with a needle-biopsy diagnosis of DCIS between 2000 and 2014, which was followed by surgical excision. Several pre-operative clinical, radiological and pathological features were assessed and correlated with the presence of invasion in the excision specimen. Features that were significantly associated with upstaging in the univariable analysis were combined to calculate upstaging risks.ResultsOverall, 22% (34/155) of the patients were upstaged to IBC. The following risk factors were significantly associated with upstaging: palpability, age ≤40 years, mammographic mass lesion, moderate to severe periductal inflammation and periductal loss of decorin expression. The upstaging-risk correlated with the number of risk factors present: e.g. 9% for patients without risk factors, 29% for patients with 1 risk factor, 37% for patients with 2 risk factors and 54% for patients with ≥3 risk factors.ConclusionThe identified risk factors may be helpful to predict the upstaging-risk for patients with a needle-biopsy diagnosis of pure DCIS, which facilitates the performance of a selective SNB for high-risk patients and avoid this procedure in low-risk patients.     

Invasive fungal infections in renal transplant patients: a single center study

Background: Timely diagnosis of invasive fungal infections (IFI) in renal transplant (RT) patients on immunosuppression is often difficult, jeopardizing their life and graft. We reported IFI and their causative fungal agents in post-RT patients.

Materials and methods: This was a retrospective 6-year clinical study carried out from 2010 to 2015 on 1900 RT patients. Clinical data included patient-donor demographics, time to onset of infection, risk factors and graft function in terms of serum creatinine (SCr). To identify IFI, we examined bronchoalveolar lavage (BAL), blood, tissue, and wound swab samples by conventional mycological methods.

Results: IFI were diagnosed in 30 (1.56%) patients on triple immunosuppression, mainly males (n?=?25) with mean age of 36.57?±?11.9 years at 13.12?±?18.35 months post-RT. Aspergillus species was identified in 11 BAL, one tissue, and one wound specimen each, 30.76% of these were fatal and 15.38% caused graft loss; Candida albicans was in nine BAL, four blood, two wound swab, and one tissue specimens, 25% of these were fatal and 25% had graft loss and one mucor in BAL which was fatal. Seven patients were diabetic, 10 had superadded cytomegalovirus infection, and 15 were anti-rejected.

Conclusion: IFI are associated with increased morbidity and mortality in RT patients. Triple immunosuppression, broad spectrum antibiotics for?≥?two weeks, diabetes and superadded infection are added risks for these patients. Prevention, early diagnosis, and appropriate management are necessary to improve their prognosis.     

Simultaneous Bilateral Total Hip Arthroplasty With Contemporary Blood Management is Associated With a Low Risk of Allogeneic Blood Transfusion

BackgroundThere is a paucity of data on blood loss and the risk of allogeneic blood transfusion after simultaneous bilateral total hip arthroplasty (SBTHA) with contemporary blood management including neuraxial anesthesia, routine tranexamic acid use, and a restrictive transfusion protocol. As such, we sought to determine the in-hospital outcomes of SBTHA, specifically analyzing blood loss and the rate and risk factors for transfusion.MethodsWe identified 191 patients who underwent SBTHA at a single institution from 2016 to 2019. No drains were utilized and no patients donated blood preoperatively. Mean age was 59 years with 96 females (50.3%). The surgical approach was posterior in 138 (72.3%) and direct anterior in 53 (27.7%) patients. We analyzed blood loss, the rate of allogeneic blood transfusions, and in-hospital thromboembolic complications. We analyzed risk factors for transfusion with a logistic regression analysis.ResultsTwenty-two patients (11.5%) underwent allogeneic blood transfusion. All transfused patients were female. Univariate analysis revealed female gender as a transfusion risk factor since it had statistically significant higher proportion in the transfusion group than the nontransfusion group (100% vs 43.5%, respectively, P < .001). We did not identify any other singular significant risk factors for transfusion in a multivariable regression analysis. However, females with a preoperative Hb <12 had an elevated risk of transfusion at 37.5% (15/40 patients).ConclusionWith contemporary perioperative blood management protocols, there is a relatively low (11.5%) risk of a blood transfusion after SBTHA. Females with a lower preoperative Hb (<12 g/dL) had the highest risk of transfusion at 37.5%.     

肝移植手术后肺部感染的危险因素分析

目的 探讨肝移植手术患者术后肺部感染的危险因素。
方法 回顾性分析2005年6月至2013年6月于三家临床医疗中心首次行原位肝移植手术的1 358例患者的临床资料。根据患者术后30 d内是否发生肺部感染将患者分成两组：感染组和非感染组。收集术前资料、术中资料及术后资料，采用单因素分析及二元Logistic回归分析肝移植术后肺部感染的危险因素。
结果 肝移植手术后有316例（23.3%）发生肺部感染，其中有21例（6.7%）死亡。与非感染组比较，感染组术前诊断为慢性重型肝炎、肝癌、丙型肝炎肝硬化、先天性肝脏疾病及肝衰竭、术前合并肝肾综合征、肝昏迷、糖尿病的比例、术前肌酐浓度明显升高（P<0.05），术前总蛋白、白蛋白浓度明显降低（P<0.05），无肝期时间、术后苏醒时间及术后拔管时间明显延长（P<0.05），术中失血量明显增加（P<0.05），术中尿量明显减少（P<0.05），术中使用去氧肾上腺素、阿托品、利多卡因及呋塞米的比例明显降低（P<0.05），术后死亡率明显升高（P<0.05）。二元Logistic回归分析显示：慢性重型肝炎、丙型肝炎肝硬化、肝衰竭、术前合并糖尿病、术中失血量>1 900 ml、术后苏醒时间>7.3 h是肝移植患者术后肺部感染的危险因素；手术方式（经典非转流原位肝移植）、术中使用利多卡因、术前总蛋白>64.6 g/L、术中尿量>1 800 ml是肝移植手术患者术后肺部感染的保护因素。
结论 术前诊断慢性重型肝炎、丙型肝炎肝硬化、肝衰竭、术前合并糖尿病、术中失血量>1 900 ml、术后苏醒时间>7.3 h是肝移植手术后肺部感染的危险因素。     

Total knee replacement under tourniquet control: A prospective study of the peripheral arterial vasculature using colour-assisted duplex ultrasonography

Background and purposeA tourniquet may potentiate rare and devastating arterial complications after total knee replacement (TKR) in patients with peripheral vascular disease (PVD). Most prior studies that evaluated peripheral arterial blood flow primarily used the ankle-brachial index (ABI).MethodsWe assessed the prevalence and risk factors for PVD in a cohort undergoing TKR. Clinical and radiological evaluations, including duplex ultrasonography, were performed one week prior to, and six weeks post-TKR performed under tourniquet control. Forty patients were analysed (20 male, 20 female; mean age 67 yrs, range: 53–80 yrs).Main findingsHypertension (50%) and hypercholesterolaemia (50%) were the most common co-morbidities. Distal pulses were present in all patients preoperatively. Six patients (15%) had arterial calcification on their preoperative knee X-rays. Three patients (7.5%) had moderate PVD. There was no change in blood flow postoperatively in patients with or without PVD (p > 0.05). Vascular stenosis was less than 50% in all patients preoperatively and postoperatively. No postoperative vascular complications occurred.ConclusionsSevere PVD is not common in patients undergoing TKR. Performing total knee replacement under tourniquet control does not adversely affect the vasculature in patients with less than 50% vascular occlusion.     

高龄髋部骨折行人工髋关节置换术后患者再入院危险因素分析

目的:探讨高龄髋部骨折行人工髋关节置换术后患者再入院的发生率及危险因素分析。方法:回顾性分析2015年2月至2020年10月接受人工髋关节置换的高龄髋部骨折患者237例,根据患者术后3个月再入院情况分为两组,其中再入院组39例,男7例,女32例,年龄(84.59±4.34)岁;未再入院组198例,男34例,女164例,年龄(84.65±4.17)岁。将两组患者的一般资料、手术情况、髋关节Harris评分和并发症纳入单因素分析,并采用多因素Logistic回归分析患者再入院的独立危险因素。结果:再入院组中合并症(脑梗死和冠心病)的比例明显高于未再入院组(P<0.05),再入院组中术中出血量明显高于未再入院组(P<0.05),髋关节Harris评分明显低于未再入院组(P<0.05)。在并发症方面,再入院组发生感染、谵妄、关节脱位、贫血和静脉血栓形成的比例明显高于未再入院组(P<0.05)。多因素Logistic回归分析显示,高龄髋部骨折行人工髋关节置换术后患者再入院危险因素包括脑梗死、感染、谵妄、关节脱位、贫血和静脉血栓形成(P<0.05)。结论:高龄髋部骨折行人工髋关节置换术后再入院的患者并发症明显高于未再入院患者,脑梗死、感染、谵妄、关节脱位、贫血和静脉血栓形成是导致患者再入院的危险因素,临床可根据这些危险因素采取相应的干预措施,以此减低患者再入院的发生率。     

Risk factors of multidrug-resistant pyogenic spondylitis in thoraco-lumbar spine: A retrospective study of 122 cases

BackgroundThe number of spinal infections has been increasing in developed countries due to the increase of aged or immunosuppressed patients. Spondylitis caused by multidrug-resistant (MDR) bacterial infection often become intractable and require long-term antibiotic therapy and multiple surgeries. Therefore, it is of great importance to understand risk factors for MDR spinal infections. The aim of this study was to elucidate the risk factors for MDR bacterial spondylitis.MethodsA total of 122 patients (82 men, 40 women; average age: 63.8 y) with thoracic/lumbar spondylitis who underwent posterolateral full-endoscopic debridement and irrigation were included. The organisms detected by this endoscopic procedure were investigated, and the incidence and risk factors for MDR bacterial infection were retrospectively analyzed.ResultsCultures of specimens obtained by endoscopic procedures were positive in 78 patients (63.9%). Among 68 isolated bacteria, MDR bacteria accounted for 47.1%. Multivariate analysis showed that significant risk factors for MDR bacterial infection included autoimmune connective tissue disease (P = 0.03) and central venous catheter (P = 0.02). The incidence of MDR bacteria in patients who were administered a broad-spectrum antibiotic for more than 1 month preoperatively was 64.0%, which was significantly higher than in patients who were administered a broad-spectrum antibiotic for less than 1 month and patients who were administered a narrow-spectrum antibiotic (P < 0.01, P < 0.01, respectively).ConclusionsThe significant risk factors for MDR bacterial spondylitis included immunosuppressed conditions, such as autoimmune connective tissue disease, presence of central venous catheter, and longer administration periods of a broad-spectrum antibiotic. In patients with pyogenic spondylitis who could not be controlled with previous antibiotics and whose result of culture was negative, administration of anti-MRSA antibiotics would be considered when they have the risk factors identified in this study.     

Increased risk of blood transfusion in patients with diabetes mellitus sustaining non-major burn injury

BackgroundDue to the increased mortality and morbidity associated with blood transfusion, identifying modifiable predictors of transfusion are vital to prevent or minimise blood use. We hypothesised that burn patients with diabetes mellitus were more likely to be prescribed a transfusion. These patients tend to have increased age, number of comorbidities, infection risk and need for surgery which are all factors reported previously to be associated with blood use.ObjectiveTo determine whether patients with diabetes mellitus who have sustained a burn ≤20% total body surface area (TBSA) are at higher risk of receiving red blood cell transfusion compared to those without diabetes mellitus.MethodThis was a retrospective cohort study including patients admitted to the major Burns Unit in Western Australia for management of a burn injury. Only the first hospital admission between May 2008 to February 2017 were included.ResultsAmong 2101 patients with burn injuries ≤20% TBSA, 48 (2.3%) received packed red blood cells and 169 (8.0%) had diabetes. There were 13 (7.7%) diabetic patients that were transfused versus 35 (1.8%) non-diabetic patients. Patients with diabetes were 5.2 (p = 0.034) times more likely to receive packed red blood cells after adjusting for percentage TBSA, haemoglobin at admission or prior to transfusion, number of surgeries, total comorbid burden and incidence of infection. As percentage TBSA increases, the probability of packed red blood cell transfusion increases at a higher rate in DM patients.ConclusionsThis study showed that diabetic patients with burn injuries ≤20% TBSA have a higher probability of receiving packed red blood cell transfusion compared to patients without diabetes. This effect was compounded in burns with higher percentage TBSA.     

Infection after operative fixation of tibia plateau fractures. A risk factor analysis

IntroductionSurgical fixation of tibial plateau fractures has been shown to improve long-term functional outcomes, but a major complication is that of postoperative infection which can be deleterious to long-term outcomes. This study aims to assess the impact of common comorbidities on the risk of postoperative infection.MethodA retrospective study of 210 consecutive operatively treated patients, treated at two Level 1 Trauma Centres over a 27-month period was performed. Records were analysed to assess the presence of the study factors; smoking, alcohol intake >13 units/week, diabetes, and BMI > 30. The impact of these factors on infection was assessed with univariate and multivariate analyses.Results175 patients were included in the study, 56.6% male with a mean age of 46.9 years (± 18.2 years). Excessive alcohol consumption of >13 units/week was the only significant risk factor for postoperative infection (p = 0.05) on multivariate analysis.ConclusionThis study has identified excessive alcohol consumption as the only independent risk factor for postoperative infection in patients with all types of tibial plateau fracture treated with operative fixation. No relationship between smoking, diabetes nor obesity was found for postoperative infection.     

Red blood cell distribution width is an independent risk factor in the prediction of acute respiratory distress syndrome after severe burns

BackgroundThe occurrence of acute respiratory distress syndrome (ARDS) significantly increases the mortality and morbidity of major burns; there are few laboratory markers that predict the development of ARDS in severe burns. This study was to investigate the relationship between complete blood count (CBC) parameters and the incidence of ARDS in severe burn patients.MethodsAn eight-year retrospective study was performed on 610 severe burn patients who were admitted to the First Affiliated Hospital of Anhui Medical University and Rui Jin Hospital of Shanghai Jiao Tong University from January 2008 to December 2015. The patients were divided into two groups based on the development of ARDS. A blood sample was taken at admission and CBC parameters were examined. Univariate logistic regression analysis was used to evaluate the risk factors for the development of ARDS.ResultsOf these 610 patients, 143 developed ARDS giving a rate of 23.44%. The percentage of deep second degree and full thickness burn, inhalation injury and red blood cell distribution width (RDW) were independently associated with the development of ARDS in severe burn patients. Every 1% increase in RDW was associated with a 29% increase in the risk to develop ARDS.ConclusionsThe findings of this study suggest that an elevated RDW is associated with an increased risk of ARDS and RDW is an independent risk factor in the prediction of ARDS after severe burns.