Risk Factors for Surgical Site Infection After Cholecystectomy.
Risk Factors for Surgical Site Infection After Cholecystectomy.
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DOI：
10.1093/ofid/ofx036
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发表时间：
2017
影响因子：
4.2
通讯作者：
Olsen MA
中科院分区：
文献类型：
--
作者：
Warren DK;Nickel KB;Wallace AE;Mines D;Tian F;Symons WJ;Fraser VJ;Olsen MA
关于开腹或腹腔镜胆囊切除术后手术部位感染（SSI）的风险因素的数据有限。使用国际疾病分类第9版临床修改（ICD-9-CM）程序或现行程序术语第4版胆囊切除术代码，从2004年12月31日至2010年12月31日，对年龄在18-64岁之间的商业保险人员进行了回顾性队列。排除了复杂手术和患者（例如，癌症、终末期肾病）以及既存感染的手术。胆囊切除术后90天内的手术部位感染通过ICD-9-CM诊断代码进行识别。采用考克斯比例风险模型识别SSI的独立风险因素。66566例胆囊切除术中有472例（0.71%）发现手术部位感染;开放手术（n = 51，4.93%）的发生率高于腹腔镜手术（n = 421，0.64%; P <0.001）。SSI的独立风险因素包括男性、术前慢性贫血、糖尿病、药物滥用、营养不良/体重减轻、肥胖、吸烟相关疾病、既往金黄色葡萄球菌感染、腹腔镜手术合并急性胆囊炎/梗阻（风险比[HR]，1.58; 95%置信区间[CI]，1.27-1.96），开放手术，（HR，4.29; 95% CI，2.45-7.52）或无急性胆囊炎/梗阻（HR，4.04; 95% CI，1.96-8.34），转为开放手术，（HR，4.71; 95% CI，2.74-8.10）或无急性胆囊炎/梗阻（HR，7.11; 95% CI，3.87-13.08）、胆管探查、术后慢性贫血和术后肺炎或尿路感染。急性胆囊炎或梗阻与腹腔镜胆囊切除术后SSI风险显著增加相关，但与开腹胆囊切除术无关。计划的开放手术和转换手术的SSI风险相似。这些结果表明，当比较不同机构之间的SSI发生率时，按手术因素进行分层很重要。
There are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy. A retrospective cohort of commercially insured persons aged 18–64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI. Surgical site infections were identified after 472 of 66566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P < .001). Independent risk factors for SSI included male gender, preoperative chronic anemia, diabetes, drug abuse, malnutrition/weight loss, obesity, smoking-related diseases, previous Staphylococcus aureus infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27–1.96), open approach with (HR, 4.29; 95% CI, 2.45–7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96–8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74–8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87–13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection. Acute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities.