What Is the Risk of Irrigation and Debridement Following Foot and Ankle Surgery? Development of a Risk Severity Scoring System.

IF 4.2 2区 医学 Q1 ORTHOPEDICS Clinical Orthopaedics and Related Research® Pub Date : 2024-12-01 Epub Date: 2024-07-15 DOI:10.1097/CORR.0000000000003177
Lisa Bonsignore-Opp, Matan S Malka, Prakash Gorroochurn, Joshua Bender, Jennifer A Kunes, Hart Fogel, Eric Schweppe, J Turner Vosseller, Justin K Greisberg
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Abstract

Background: Surgical site infection (SSI) after foot and ankle surgery has serious negative effects on patient health and quality of life. While previous studies have looked at predisposing factors for SSI, to our knowledge, no study has proposed a risk severity score.

Questions/purposes: Can a risk severity score, based on patient demographic characteristics and surgical variables, be developed for preoperative use in patients undergoing foot and ankle surgery that will calculate the risk of an irrigation and debridement (I&D) procedure within 90 days of surgery utilizing data from previous surgeries?

Methods: A retrospective chart study was performed on patients undergoing foot and ankle surgery. Data on demographic characteristics including age, sex, and BMI were recorded. Data on patient factors including diabetes and smoking history were also recorded. Surgical details including length of surgery, procedure type, surgeon, antibiotic delivery time, antibiotic type, and antibiotic dose were analyzed. Of 2979 procedures, 1% (36) of I&Ds were performed within 90 days. The mean age at surgery was 49 ± 17 years, and 57% (1702) of patients were female. The mean BMI was 28 ± 6 kg/m 2 . The primary outcome was I&D within 90 days postoperatively. Descriptive statistics of differences in patient characteristics between those who underwent I&D and those who did not were examined using chi-square tests and t-tests (p < 0.05 was taken as significant). Significant variables from a simple regression analysis were included in a multiple logistic regression model with a forward stepwise procedure for variable selection. We required all data in the model to be categorical; thus, continuous variables such as time were dichotomized. We factored odds ratios determined by multiple regression for significant variables into the final risk severity score, and an easy-to-use tool based on this risk severity score was created in Excel (Microsoft).

Results: Current tobacco use, diabetes, and longer operative times were the only factors associated with I&D within 90 days postoperatively. A risk severity score was developed using current tobacco use, diabetes, and length of surgery greater than 60 minutes as factors. A patient with a severity score of 0 (no risk factors) had a 0.6% chance of I&D within 90 days, while a severity score of 1 indicated a 1.1% chance, a score of 2 indicated a 2.1% chance, a score of 3 indicated a 4.0% chance, and a score of 4 (all risk factors) indicated a 7.5% chance of I&D within 90 days. A spreadsheet that can be used at the point of care was created based on these findings.

Conclusion: Our risk severity score may help inform preoperative patient guidance and operative planning. Calculating the score in the office setting during preoperative visits can also improve communication between physician and patient. Future research should focus on validation of this risk severity score at multiple institutions.

Level of evidence: Level III, prognostic study.

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足踝手术后冲洗和清创的风险有多大?风险严重程度评分系统的开发。
背景:足踝手术后的手术部位感染(SSI)会对患者的健康和生活质量造成严重的负面影响。据我们所知,以往的研究已对 SSI 的易感因素进行了调查,但还没有研究提出风险严重程度评分:问题/目的:能否根据患者的人口统计学特征和手术变量制定一个风险严重程度评分,供接受足踝手术的患者术前使用,该评分将利用以往手术的数据计算手术后 90 天内进行冲洗和清创(I&D)手术的风险?对接受足踝手术的患者进行了一项回顾性病历研究。记录了包括年龄、性别和体重指数在内的人口统计学特征数据。还记录了包括糖尿病和吸烟史在内的患者因素数据。分析了手术细节,包括手术时间、手术类型、外科医生、抗生素给药时间、抗生素类型和抗生素剂量。在 2979 例手术中,1%(36 例)的 I&D 在 90 天内完成。手术时的平均年龄为 49 ± 17 岁,57%(1702 例)的患者为女性。平均体重指数为 28 ± 6 kg/m2。主要研究结果为术后 90 天内的 I&D。采用卡方检验和 t 检验(P < 0.05 为显著)对接受和未接受 I&D 的患者特征差异进行了描述性统计。简单回归分析中的重要变量被纳入多元逻辑回归模型,并采用前向逐步法进行变量选择。我们要求模型中的所有数据都是分类数据;因此,时间等连续变量被二分化。我们将多元回归确定的重要变量的几率系数纳入最终的风险严重性评分,并根据该风险严重性评分在 Excel(Microsoft)中创建了一个易于使用的工具:结果:目前吸烟、糖尿病和手术时间较长是与术后 90 天内 I&D 相关的唯一因素。以目前吸烟、糖尿病和手术时间超过 60 分钟为因素,制定了风险严重程度评分。严重程度为 0 分(无风险因素)的患者在 90 天内发生 I&D 的几率为 0.6%,严重程度为 1 分的患者发生 I&D 的几率为 1.1%,为 2 分的患者发生 I&D 的几率为 2.1%,为 3 分的患者发生 I&D 的几率为 4.0%,为 4 分(所有风险因素)的患者发生 I&D 的几率为 7.5%。根据这些结果,我们制作了一张可在护理点使用的电子表格:我们的风险严重程度评分有助于为术前患者指导和手术计划提供依据。术前就诊时在诊室计算该评分还能改善医生和患者之间的沟通。未来的研究应侧重于在多个机构验证该风险严重程度评分:III级,预后研究。
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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
期刊最新文献
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