The Role of Anesthetic Management in Surgical Site Infections After Pediatric Intestinal Surgery.
The Role of Anesthetic Management in Surgical Site Infections After Pediatric Intestinal Surgery.
复制标题
DOI：
10.1016/j.jss.2020.10.015
复制
发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Yuki K
中科院分区：
文献类型：
--
作者：
Shibamura-Fujiogi M;Ormsby J;Breibart M;Zalieckas J;Sandora TJ;Priebe GP;Yuki K
尽管手术部位感染（ssi）仍然是一个重要的卫生保健问题，但有限数量的研究分析了儿童ssi的危险因素，特别是术中麻醉管理的作用。儿科患者不太可能有主要的成人危险因素，如吸烟和糖尿病。因此，儿童可能更适合作为研究术中麻醉药在ssi中的作用的队列。我们研究了在单一机构中接受择期肠道手术的儿童SSI发生率与麻醉管理之间的关系。我们对2017年1月至2019年9月期间在全身麻醉下接受选择性肠道手术的621例患者进行了回顾性研究，主要结局为SSI的发生率。我们比较了根据七氟醚剂量中位数进行二分类的患者。我们使用倾向评分（PS）对这些患者进行两两匹配以避免选择偏差。PS配对产生204对患者。我们发现，高剂量的七氟醚与较高的ssi发生率相关（9.8%比3.9%,p = 0.019）。我们对PS调整因素中未包括的术中因素进行调整，PS匹配后的多因素回归分析结果一致（优势比：2.58,95%可信区间：1.11-6.04,p=0.028）。高剂量七氟醚与儿童择期肠道手术后SSI发生率增加相关。为了进一步确定麻醉药物在SSI风险中的作用，需要对挥发性麻醉和静脉麻醉进行随机对照研究。
Although surgical site infections (SSIs) remain a significant health care issue, a limited number of studies have analyzed risk factors for SSIs in children, particularly the role of intraoperative anesthetic management. Pediatric patients are less likely to have major adult risk factors for SSIs such as smoking and diabetes. Thus children may be more suitable as a cohort for examining the role of intraoperative anesthetics in SSIs. We examined an association between SSI incidence and anesthetic management in children who underwent elective intestinal surgery in a single institution. We performed a retrospective study of 621 patients who underwent elective intestinal surgery under general anesthesia between January 2017 and September 2019, with primary outcome as the incidence of SSI. We compared patients who were dichotomized according to the median of the sevoflurane dose. We used propensity score (PS) pairwise matching of these patients to avoid selection biases. PS matching yielded 204 pairs of patients. We found that higher doses of sevoflurane were associated with higher incidence of SSIs (9.8% vs. 3.9%, p = 0.019). We adjusted for intraoperative factors that were not included in the PS adjustment factors, and multivariate regression analysis after PS matching showed compatible results (odds ratio: 2.58, 95% confidence interval: 1.11–6.04, p=0.028). Higher doses of sevoflurane are associated with an increased odds of SSI after pediatric elective intestinal surgery. A randomized controlled study of volatile anesthetic-based versus intravenous anesthetic-based anesthesia will be needed to further determine the role of anesthetic drugs in SSI risk.
登录
查看更多内容
影响因子：
8.8
作者：
LERMAN, J;SIKICH, N;YENTIS, S
通讯作者：
YENTIS, S
影响因子：
8.8
作者：
Chang, Chuen-Chau;Lin, Hsiu-Chen;Lin, Herng-Ching
通讯作者：
Lin, Herng-Ching
影响因子：
8.8
作者：
Kotani, N;Hashimoto, H;Matsuki, A
通讯作者：
Matsuki, A
影响因子：
2.2
作者：
Koutsogiannaki, Sophia;Bernier, Rachel;Yuki, Koichi
通讯作者：
Yuki, Koichi
影响因子：
1.7
作者：
Lee, Joshua;Faraoni, David;Yuki, Koichi
通讯作者：
Yuki, Koichi