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Neurological Surgery No Shinkei Geka Volume 41, Issue 7 （July 2013）

Neurological Surgery 脳神経外科 41巻7号（2013年7月発行）

Japanese English

研究

脊椎脊髄手術後の手術部位深部感染症（deep incisional Surgical Site Infection：dSSI）に関する検討 Evaluation of Deep Infection of the Surgical Site after Spine Surgery 関俊隆 ^1,3 , 木村輝夫 ¹ , 杉村敏秀 ¹ , 川崎和凡 ¹ , 宮野真 ¹ , 福田信 ¹ , 橋本政明 ² Toshitaka SEKI ^1,3 , Teruo KIMURA ¹ , Toshihide SUGIMURA ¹ , Kazutsune KAWASAKI ¹ , Makoto MIYANO ¹ , Sin FUKUDA ¹ , Masaaki HASHIMOTO ² ¹社会医療法人明生会道東脳神経外科病院脳神経外科 ²社会医療法人明生会網走脳神経外科・リハビリテーション病院脳神経外科 ³北海道大学大学院医学研究科脳神経外科 ¹Department of Neurosurgery, Dohtoh Neurosurgical Hospital ²Department of Neurosurgery, Abashiri Neurosurgical Rehabilitation Hospital ³Department of Neurosurgery, Hokkaido University Graduate School of Medicine キーワード： multivariate logistic regression , risk factor , spine , surgery , surgical site infection Keyword: multivariate logistic regression , risk factor , spine , surgery , surgical site infection pp.593-599

発行日 2013年7月10日 Published Date 2013/7/10

DOI https://doi.org/10.11477/mf.1436102032

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Ⅰ．はじめに

　脊椎脊髄手術後の手術部位感染症（surgical site infection：SSI）は早期に診断し，適切な処置が行われなかった場合は重篤化し，治療に難渋することがある．近年の，抗生剤の使用による多剤耐性菌の出現，糖尿病，慢性腎疾患，免疫抑制剤や抗がん剤の多用，後天性免疫不全症候群（AIDS）といった易感染性宿主に対する手術や，高齢者に対する手術，さらにインストルメンテーションを使用した手術の増加などによって，今後ますますSSIの危険性は高くなってくると思われる．SSIは，患者のquality of lifeを損なうだけではなく，医療従事者に対しても多大な精神的負担を与える．また，在院日数や医療費の増加など，さまざまな問題を含んでいる^3,7,16,23)．今回われわれは，当院における脊椎脊髄手術後の手術部位深部感染症（deep incisional SSI：dSSI）について検討したので報告する．

　Objective:Surgical site infection（SSI）is commonly seen following spinal surgery, and it can be associated with serious morbidity, mortality, and increased resource utilization. The objective of this study was to identify specific independent risk factors for SSI occurring after spinal surgery.

　Methods:We performed a retrospective study of patients who had spinal surgeries performed from January 2007 to July 2012 at our hospital. 10 patients with deep incisional SSI（dSSI）were identified and compared with 304 uninfected control patients. Risk factors for dSSI were determined with Mann-Whitney's U test, univariate analyses, and multivariate logistic regression.

　Results:The overall rate of dSSI was 3.2%（10 of 314). Mann-Whitney's U test and univariate analyses showed surgery time and duration of postoperative drainage to be significantly higher in patients in whom dSSI developed than in uninfected control patients. Independent risk factors for dSSI that were identified by multivariate analysis were surgery time（odds ratio＝9.891, 95% confidence interval＝2.434-40.195).

　Conclusion:We identified independent risk factors for dSSI. Surgery time was associated with the highest independent risk of spinal surgical site infection. Duration of postoperative drainage was associated with a significantly increased risk of dSSI in Mann-Whitney's U test and the univariate analysis. However, it did not remain significantly different in multivariate analysis（p value＝0.0854, odds ratio＝3.227, 95% confidence interval＝0.849-12.262).