Balancing the Risk of Postoperative Surgical Infections A Multivariate Analysis of Factors Associated With Laparoscopic Appendectomy From the NSQIP Database
Balancing the Risk of Postoperative Surgical Infections A Multivariate Analysis of Factors Associated With Laparoscopic Appendectomy From the NSQIP Database
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DOI：
10.1097/sla.0b013e3181f194fe
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发表时间：
2010-12-01
影响因子：
9
通讯作者：
Monson, John R.
中科院分区：
文献类型：
--
作者：
Fleming, Fergal J.;Kim, Michael J.;Monson, John R.
目的：建立不受潜在混杂因素影响的阑尾切除术后手术方式(腹腔镜术或开腹术)与手术感染(包括切口部感染和器官间隙感染)之间的关系。背景：尽管与开腹手术相比，腹腔镜阑尾切除术的切口感染率较低，但其与器官间隙感染(OSI)的关系尚不清楚。方法：从美国外科医师学会国家外科质量改进计划(NSQIP)数据库中检索2005-2008年间的阑尾切除病例。记录患者因素、手术变量、切口感染和OSIS的主要结果。使用Logistic回归模型确定与外科感染相关的因素。然后，这些模型被用来计算临床期间OSI的概率，显示出不同水平的感染风险。结果：共有39,950例阑尾切除术，其中30,575例(77%)在腹腔镜下完成。多因素分析显示，腹腔镜组发生切口感染的风险较低[优势比(OR)0.37，95%可信区间(CI)0.32~0.43]，但调整混杂因素后OSI的风险增加(OR 1.44，95%CI 1.21~1.73)。对于低风险患者，开腹和腹腔镜阑尾切除术发生OSI的概率分别为0.3%和0.4%，而对于高危患者，OSI的概率估计分别为8.9%和12.3%。结论：腹腔镜术降低了切口感染的风险，但增加了OSI的风险。这种风险增加的程度取决于外科患者的临床特征。认识到这些风险的差异可能有助于临床医生选择阑尾切除术的手术方式。
Objective: To establish the relationship between operative approach (laparoscopic or open) and subsequent surgical infection (both incisional and organ space infection) postappendectomy, independent of potential confounding factors. Background: Although laparoscopic appendectomy has been associated with lower rates of incisional infections than an open approach, the relationship between laparoscopy and organ space infection (OSI) is not as clearly established. Methods: Cases of appendectomy were retrieved from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for 2005 to 2008. Patient factors, operative variables, and the primary outcomes of incisional infections and OSIs were recorded. Factors associated with surgical infections were identified using logistic regression models. These models were then used to calculate probabilities of OSI in clinical vignettes demonstrating varying levels of infectious risk. Results: A total of 39,950 appendectomy cases were included of which 30,575 (77%) were performed laparoscopically. On multivariate analysis, laparoscopy was associated with a lower risk of incisional infection [odds ratio (OR) 0.37, 95% confidence interval (CI) 0.32-0.43] but with an increased risk of OSI after adjustment for confounding factors (OR 1.44, 95% CI 1.21-1.73). For a low-risk patient, probability of OSI was calculated to be 0.3% and 0.4%, respectively, for open versus laparoscopic appendectomy, whereas for a high-risk patient, probabilities were estimated at 8.9% and 12.3%, respectively. Conclusion: Laparoscopy was associated with a decreased risk of incisional infection but with an increased risk of OSI. The degree of this increased risk varies depending on the clinical profile of a surgical patient. Recognition of these differences in risk may aid clinicians in the choice of operative approach for appendectomy.