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DOI: 10.1055/a-2246-0792
Prävention postoperativer Wundinfektionen nach Korrektur neuromuskulärer Skoliosen
Anwendung eines epikutanen VakuumverbandesPrevention of Postoperative Wound-infection after Correction of Neuromuscular ScoliosisUse of Epicutaneous Vacuum-dressing
Zusammenfassung
Ziel der Studie Identifikation von Faktoren, welche postoperative Wundinfektionen bei operativ therapierten neuromuskulären Skoliosen (NMS) beeinflussen und wie diesen präventiv zu begegnen ist.
Material und Methoden Erhoben wurden Daten von 2016–2020 von Patienten mit einer dorsal einzeitig korrigierten NMS mit einem Mindestnachbetrachtungszeitraum von 12 Monaten. Ab Herbst 2018 erfolgte die Verwendung eines perioperativ applizierten epikutanen Vakuumverbands (EV) für 5 Tage. Die postoperative Infektionsrate und das verursachende Keimspektrum wurden analysiert.
Ergebnisse 83 Patienten (m : f 39 : 44) wurden eingeschlossen. Gruppe 1 (ohne EV) umfasste 48 Patienten, Gruppe 2 (mit EV) 35. Das durchschnittliche Alter bei OP betrug 16,6 ± 4,94 Jahre. 60 Patienten waren inkontinent, 58 nicht geh- und stehfähig. Der präoperative Cobb-Winkel der Hauptkrümmung belief sich auf 87,7 ± 18,4°, die pelvic obliquity auf 18,4 ± 12,25°. Die fusionierte Strecke umfasste 14,59 ± 1,65 Wirbelkörper, bei einer durchschnittlichen OP-Dauer von 221 ± 49 min. Die OP-Dauer in Gruppe 2 war geringgradig kürzer (229,92 vs. 216,93 min, p=0,1) ohne einen Unterschied bzgl. der fusionierten Strecke (14,63 vs. 14,48 Wirbel, p=0,35). Patienten, bei denen eine Wundinfektion auftrat, hatten eine nicht-signifikant längere Instrumentationsstrecke (15,16 Wirbel, p=0,1) und längere OP-Dauer (246,2 min, p=0,19). Gruppe 1 wies 7 Infektionen auf (14,5%), davon 4 verursacht durch Fäkal-Keime, 3 durch Hautkeime. In Gruppe 2 trat keine Infektion auf (p<0,05). Patienten mit einer Infektion wurden 3-mal ± 1,2-mal revidiert. Die Dauer der postoperativ notwendigen intensivmedizinischen Behandlung stieg bei Infektion von 80,6 ± 132,7 auf 457,6 ± 315,8 h (p<0,05), der stationäre Aufenthalt verlängerte sich von 14,31 ± 5,65 d auf 34,3 ± 21,6 d (p<0,05). Es wurde eine antiinfektive Therapie über 56,1 ± 28,58 d verabreicht (16,3 ± 8,7 d i.v., 39,8 ± 24,4 d p.o.).
Schlussfolgerung Die Verwendung eines epikuanten Vakuumverbandes für 5 Tage nach operativer Korrektur einer NMS reduziert die Rate von Wundinfektionen signifikant.
Abstract
Objective Identification of determining factors on postoperative wound infection and validating preventive measures as clinical guidelines in the surgical treatment of neuromuscular scoliosis (NMS).
Methods Data was collected from patients with instrumented correction and fusion in NMS between 2016 and 2020. Minimum follow-up was 12 months. From autumn 2018 on postoperatively an epicutaneous vacuum-dressing (EV) was applied for 5 days. Rates of postoperative infection and the causing type of bacteria were analyzed in all patients with NMS treated surgically during the period of 24 months before and after implementation of this dressing technique.
Results 83 patients (m : f 39 : 44) met the inclusion criteria. Group 1 (without EV) included 48 patients, group 2 (with EV) 35. Average age at surgery was 16,6 ± 4,94 years. 60 patients were incontinent, 58 were non-ambulatory. GMFCS-Score was 4,18 + 1,2. Average preoperative Cobb-angle of the main curve measured 87,7 ± 18,4°, pelvic obliquity 18,4 ± 12,25°. Length of fusion averaged 14,59 ± 1,65 vertebrae, average OR time 221 ± 49 min. Patients with a postoperative wound infection had slightly more vertebrae included (15,16 vertebrae, p=0,1) and a longer duration of surgery (246,2 min, p=0,19). There were 7 infections in group 1 (14,5%), 4 caused by fecal bacteria, 3 by bacteria usually found on the skin. Group 2 had no infections (p<0,05). Patients with infection underwent 3 ± 1,2 revisions, 2 patients had cardiopulmonary resuscitation. The postoperative stay on ICU rises from 80,6 ± 132,7 to 457,6 ± 315,8 h (p<0,05), the hospitalization from 14,31 ± 5,65 d to 34,3 ± 21,6 d (p<0,05) in the infection group. Antibiotics were applied 56,1 ± 28,58 d (16,3 ± 8,7 d i.v., 39,8 ± 24,4 d p.o.).
Conclusion The application of an epicutaneous vacuum-dressing for 5 days post-surgery significantly reduces rates of infections and its complications among patients with NMS.
Publikationsverlauf
Artikel online veröffentlicht:
13. August 2024
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