立即使用蒸汽灭菌与骨科手术部位感染发生率的关系

Tyler J Tantillo, Erik J. Stapleton, Nicholas Frane, M. Gorlin, M. Schilling, D. Armellino, Gus Katsigiorgis, A. Bitterman
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引用次数: 2

摘要

背景:立即使用蒸汽灭菌(IUSS),以前称为“闪蒸”灭菌,历来用于在紧急情况下对手术器械进行灭菌。严格的指导方针阻止其使用,因为理论上IUSS会增加手术部位感染(ssi)的风险,导致医疗保健成本增加和患者预后不良。我们试图研究使用IUSS与骨科ssi发生率之间的关系。方法:回顾性分析2014年1月至2020年12月70,600例骨科手术(全膝关节或髋关节置换术,椎板切除术或脊柱融合)的病例,以用于IUSS的应用。在这一组中,有3526名患者在手术期间使用了IUSS。进行倾向评分匹配(PSM)分析,以解释ssi的已知预测因素,共包括7,052例患者。风险差异(RD)、相对风险(RR)、优势比(OR)和McNemar检验比较了手术中包括IUSS和未包括IUSS的患者的SSI风险。结果:倾向评分匹配后,7052例匹配患者中有111例(1.57%)发生SSI。111例患者中,IUSS组61例(54.95%),非IUSS组50例(45.05%)。非IUSS组患者发生SSI的估计概率为1.42%,而IUSS组为1.73% (RR = 0.82[95%可信区间(CI)]: 0.57至1.19],RD = -0.3% [95% CI: -0.9%至0.27%])。没有证据表明IUSS组的SSI比例更大(McNemar检验,p > 0.29)。结论:接受骨科手术的IUSS和非IUSS患者的SSI发生率无显著差异。未来的前瞻性研究需要进一步探索IUSS在骨科手术中的应用。证据等级:治疗性III级。有关证据水平的完整描述,请参见作者说明。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Association of Immediate-Use Steam Sterilization with the Incidence of Orthopaedic Surgical Site Infections
Background: Immediate-use steam sterilization (IUSS), formerly termed “flash” sterilization, has been historically used to sterilize surgical instruments in emergency situations. Strict guidelines deter its use, as IUSS has been theorized to increase the risk of surgical site infections (SSIs), leading to increased health-care costs and poor patient outcomes. We sought to examine the association between the use of IUSS and the rate of orthopaedic SSIs. Methods: The cases of 70,600 patients who underwent orthopaedic surgery—total knee or hip arthroplasty, laminectomy, or spinal fusion—from January 2014 to December 2020, were retrospectively reviewed for IUSS use. Of this group, 3,526 patients had had IUSS used during surgery. A propensity score-matched (PSM) analysis was conducted to account for known predictors of SSIs and included a total of 7,052 patients. The risk difference (RD), relative risk (RR), odds ratio (OR), and McNemar test compared the SSI risk for patients whose procedure had included the use of IUSS and those whose procedure had not included IUSS. Results: After propensity score matching, 111 (1.57%) of the 7,052 matched patients developed an SSI. Of the 111 patients, 61 (54.95%) were in the IUSS group and 50 (45.05%) were in the non-IUSS group. The estimated probability for developing an SSI was 1.42% for the patients in the non-IUSS group versus 1.73% for the patients in the IUSS group (RR = 0.82 [95% confidence interval (CI)]: 0.57 to 1.19], RD = –0.3% [95% CI: –0.9% to 0.27%]).There was no evidence that the proportion of SSI was greater in the IUSS group (McNemar test, p > 0.29). Conclusions: SSI rates were not significantly different between IUSS and non-IUSS patients undergoing orthopaedic surgery. Future prospective studies are warranted to further explore the utility of IUSS during orthopaedic procedures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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