评估腰椎手术患者术前耐甲氧西林金黄色葡萄球菌（MRSA）定植的术后感染和并发症的风险

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery Pub Date : 2025-08-19 DOI:10.1007/s00402-025-06036-y

Sri Tummala, Drew Haslam, David Gibbs, Jason Alder, Joseph Chavarria, Ioannis Avramis, James Rizkalla

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引用次数: 0

摘要

术前耐甲氧西林金黄色葡萄球菌（MRSA）定植是骨科手术中手术部位感染（ssi）的已知危险因素。然而，它对各种术后并发症的影响，特别是在择期腰椎手术（LSS）中，仍未被研究。本研究评估了术前MRSA定植与LSS患者术后30天综合预后之间的关系。材料和方法使用TriNetX多机构数据库进行回顾性队列研究，包括440,336例选择性LSS患者。患者被分为mrsa定植组（n = 3,711, 0.84%）和非mrsa定植组（n = 436,625）。倾向评分匹配（1:1）根据人口统计学和合并症（年龄、种族、性别、肥胖、糖尿病、吸烟、营养不良、慢性肾脏疾病）进行调整，每组3706例患者。主要结局包括30天死亡率、ssi、全身感染（败血症、肺炎）、血液学并发症（贫血、输血）、肾功能衰竭和血栓栓塞事件。计算95%置信区间的风险比（RR）。结果smrsa定殖患者的并发症风险明显高于对照组：伤口并发症：浅表SSI （RR = 2.291, p < 0.01）、深部SSI （RR = 2.566, p < 0.01）、伤口裂开（RR = 1.722, p < 0.01）。全身性感染：败血症（RR = 2.865, p < 0.001），肺炎（RR = 2.212, p < 0.001）。血液/肾脏事件：输血（RR = 2.382, p < 0.001），贫血（RR = 2.826, p < 0.001），急性肾衰竭（RR = 2.344, p < 0.001）。死亡率：全因死亡率高出2.05倍（RR = 2.046, p < 0.01）。人口统计学分析确定了五个主要的危险因素：肥胖、糖尿病、吸烟、营养不良和慢性肾脏疾病（CKD）是MRSA定植的独立预测因素。结论选择性LSS术后MRSA定殖与死亡率、伤口并发症、全身感染、血液学发病率和急性肾损伤的风险显著升高独立相关。临床上，术前对MRSA定植的识别可以促进多模式非定植方案的实施，并针对高并发症风险进行有针对性的咨询。这种风险分层的方法可以优化高危LSS患者的围手术期管理，改善预后。

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Evaluating the Risk of Postoperative Infection and Complications in Lumbar Spine Surgery Patients with Preoperative Methicillin-resistant Staphylococcus aureus (MRSA) Colonization

Introduction

Preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization is a known risk factor for surgical site infections (SSIs) in orthopaedic procedures. However, its impact on a comprehensive range of postoperative complications, particularly in elective lumbar spine surgery (LSS), remains unexplored. This study evaluated the association between preoperative MRSA colonization and a comprehensive set of 30-day postoperative outcomes in patients undergoing LSS.

Materials and methods

A retrospective cohort study was conducted using the TriNetX multi-institutional database, including 440,336 patients undergoing elective LSS. Patients were stratified into MRSA-colonized (n = 3,711; 0.84%) and non-colonized controls (n = 436,625). Propensity score matching (1:1) adjusted for demographics and comorbidities (age, race, sex, obesity, diabetes, tobacco use, malnutrition, chronic kidney disease), yielding balanced cohorts of 3,706 patients each. Primary outcomes included 30-day mortality, SSIs, systemic infections (sepsis, pneumonia), hematologic complications (anemia, transfusions), renal failure, and thromboembolic events. Risk ratios (RR) with 95% confidence intervals were calculated.

Results

MRSA-colonized patients exhibited significantly higher complication risks versus matched controls: Wound complications: superficial SSI (RR = 2.291, p < 0.01), deep SSI (RR = 2.566, p < 0.01), wound dehiscence (RR = 1.722, p < 0.01). Systemic Infections: sepsis (RR = 2.865, p < 0.001), pneumonia (RR = 2.212, p < 0.001). Hematologic/renal events: transfusion (RR = 2.382, p < 0.001), anemia (RR = 2.826, p < 0.001), acute kidney failure (RR = 2.344, p < 0.001). Mortality: all-cause mortality was 2.05-fold higher (RR = 2.046, p < 0.01). Demographic analysis identified five major risk factors: obesity, diabetes, tobacco use, malnutrition, and chronic kidney disease (CKD) as independent predictors of MRSA colonization.

Conclusions

Preoperative MRSA colonization is independently associated with significantly elevated risks of mortality, wound complications, systemic infections, hematologic morbidity, and acute renal injury after elective LSS. Clinically, preoperative recognition of MRSA colonization could prompt implementation of multimodal decolonization protocols and targeted counseling regarding heightened complication risks. This risk-stratified approach may optimize perioperative management and improve outcomes in high-risk LSS patients.

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).