Brief review
이 논문은 퇴행성
척추질환으로 후방경유
요추 유합술을
시행한 817명의 환자
데이터를 리뷰하여
감염에 영향을
끼칠 수
있는 요소를
밝힌 논문 입니다.
감염과 연관된 요소를 밝히기 위해 ‘단계적 다변량 비례 위험도 회기 분석법’을 이용하였습니다.
결과적으로, 연령의 증가와 당뇨병, 비만, 이전의 척추수술 경험 및 재원일수의 증가 등이 후방 경유 요추 유합술 후의 감염의 위험성을 증가시킬 수 있는 요인으로 드러났습니다.
*Title: Risk
of infection following posterior instrumented lumbar fusion for degenerative
spine disease in 817 consecutive cases
퇴행성
척추질환으로 후방 경유
요추 유합술을 시행한
817명 환자들의 감염
위험성
*Authors: Kaisorn L. Chaichana, M.D., Mohamad Bydon,
M.D., David R. Santiago-Dieppa, M.D., Lee Hwang, M.D., Gregory McLoughlin,
M.D., Daniel M. Sciubba, M.D., Jean-Paul Wolinsky, M.D., Ali Bydon, M.D., Ziya
L. Gokaslan, M.D., and Timothy Witham, M.D.Department of Neurosurgery, Johns
Hopkins University School of Medicine, Baltimore, Maryland
*Bibliography: J Neurosurg Spine 20:45–52, 2014
Summary of
Background
Posterior lumbar spinal fusion for degenerative spine
disease is a common procedure, and its use is increasing annually. The rate of
infection, as well as the factors associated with an increased risk of
infection, remains unclear for this patient population. A better understanding
of these features may help guide treatment strategies aimed at minimizing
infection for this relatively common procedure.
Object
To ascertain the incidence of postoperative spinal
infections and identify factors associated with postoperative spinal
infections.
Methods
▶Subject: patients underwent
instrumented posterior lumbar fusion for degenerative spine disease (1993~2010)
“Stepwise multivariate proportional hazards regression
analysis” was used to identify factors associated with infection.
Variables with p < 0.05 were considered statistically
significant.
Results
▶Total subjects: 817
patients underwent lumbar fusion
▶Infection patients: 37(4.5%)
-21 (57%) required operative intervention but only 3 (8%)
required instrumentation removal as part of their infection management.
▶The factors independently
associated with an increased risk of infection.
1) increasing age (RR 1.004 [95% CI 1.001–1.009],
p = 0.049)
2) diabetes (RR 5.583 [95% CI 1.322–19.737], p =
0.02)
3) obesity (RR 6.216 [95% CI 1.832–9.338], p =
0.005)
4) previous spine surgery (RR 2.994 [95% CI
1.263–9.346], p = 0.009)
5) increasing duration of hospital stay (RR 1.155
[95% CI 1.076–1.230], p = 0.003)
Conclusions
-older age, diabetes, obesity, prior
spine surgery, and length of hospital stay: independently associated with an
increased risk of infection in lumbar fusion for degenerative spine disease
-The overwhelming majority of these patients were treated
effectively without hardware removal.
