| Objective:To study the risk factors of Surgical Site Infections(SSI)and establish a nomogram warning model,and to explore the treatment methods and risk factors of multiple debridement in patients with deep SSI.Methods:Retrospective analysis was performed on 2030 patients who underwent spinal surgery in our hospital from January 2019 to December 2021,and the patients were divided into infected group and non-infected group according to whether the surgical site was infected or not.At the same time,the patients with deep SSI were divided into single debridement and multiple debridement groups,and the clinical data of the two groups were univariate analysis,and the risk factors of spinal surgical site infection and multiple debridement were screened by binary Logistic regression analysis.R(R4.1.3)software was used to establish the alignment chart model and verify the accuracy of the model.The optimal critical value of relevant measurement data was analyzed by the receiver operating characteristic curve.Results:Among the 2030 patients,74 patients were diagnosed with postoperative SSI,accounting for 3.65%(74/2030).Fifty-nine strains of pathogenic bacteria were cultured from secretions,and Staphylococcus aureus,Escherichia coli and Staphylococcus epidermidis accounted for 37.29%,16.95%and 15.25%,respectively.After univariate analysis,there were statistically significant differences in BMI,smoking history,anemia,diabetes,operative time,surgical approach,intraoperative blood loss,internal fixation,ASA grade,incision length,postoperative closed drainage time and other factors between the infected group and the non-infected group(P<0.05).The factors with statistical significance in univariate analysis were set as independent variables.With the incidence of SSI after spinal surgery as the dependent variable,Binary Logistic regression analysis showed that smoking history,diabetes mellitus,operation time ≥ 3h,intraoperative blood loss≥300ml,ASA grade≥ 3,postoperative closed drainage time≥ 5d,incision length≥10cm,BMI≥30kg/m2 and internal fixation were the risk factors for postoperative SSI(P<0.05).The above nine risk factors were used to construct a risk nomogram model for predicting the occurrence of SSI after spinal surgery.The total score was 180～455 points,corresponding to the probability of SSI after spinal surgery was 0.1～0.8.The C-index of the model was 0.779(95%CI:0.741-0.824),and the AUC of the column graph was 0.845.The corrected curve was basically consistent with the ideal curve,indicating that the prediction accuracy of the model was high.The rate of multiple debridement in deep SSI patients was 32.31%(21/65).In the single and multiple debridement groups,Subcutaneous fat thickness(critical value 28.90mm),hypoalbuminemia(critical value 32.96g/L),diabetes(OR=9.072),co-infection(OR=10.550),MRSA infection(OR=14.076)were risk factors for multiple debridement(P<0.05).Conclusion:1.The incidence of SSI after spinal surgery is 3.65%,and Staphylococcus aureus and Escherichia coli are the most common pathogens.Smoking history,diabetes mellitus,operation time≥3h,intraoperative blood loss≥300ml,ASA grade≥ 3,postoperative closed drainage time≥5d,incision length≥10cm,BMI≥30kg/m2 and internal fixation are the risk factors for SSI after spine surgery.The prediction accuracy of risk alignment chart model is high.2.Hyperthick subcutaneous fat,hypoalbuminemia,diabetes,co-infection and MRSA infection are the risk factors for postoperative debridement,among which MRSA infection,co-infection of lung and diabetes may have significant influence on SSI. |
