Risk factors for surgical site infection after major breast operation
Risk factors for surgical site infection after major breast operation
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DOI：
10.1016/j.jamcollsurg.2008.04.021
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发表时间：
2008-09-01
影响因子：
5.2
通讯作者：
Fraser, Victoria J.
中科院分区：
文献类型：
--
作者：
Olsen, Margaret A.;Lefta, Mellani;Fraser, Victoria J.
背景：了解乳房手术后手术部位感染(SSI)的危险因素对于制定感染预防策略和改善手术效果至关重要。方法：我们对1998年1月至2002年6月在一所大学附属医院接受乳房切除、乳房重建和乳房缩小手术的患者进行了一项回顾性病例对照研究。术后1年内的SSI病例采用ICD9-CM伤口感染和并发症诊断代码或伤口培养阳性或两者兼而有之。本文回顾了57例乳腺SSI患者和268例随机抽取的非感染对照患者的病历。结果：乳房切口SSI的显著独立危险因素包括乳房植入物或组织扩张器(OR=5.3；95%CI，2.5~11.1)、预防性抗生素用量不佳(OR=5.1；9.5%CI，2.5~10.2)、输血(OR=3.4；95%CI，1.3~9.0)、乳房切除(OR=3.3；95%可信区间1.4~7.7)、既往胸部放疗史(OR=2.8；95%可信区间1.2~6.5)、现在或最近吸烟(OR=2.1；95%可信区间0.9~4.9)。局部麻醉剂的渗透与SSI的发生几率显著降低相关(OR 0.4；95%CI，0.1~0.9)。结论：预防性抗生素的次佳剂量是乳房手术后SSI的潜在可改变的危险因素。接受乳房切除术的患者和在术中放置植入物或组织扩张器的患者SSI的风险增加。这些信息可用于制定特定的风险分层指数，以预测SSI和为乳房手术患者量身定做的感染预防策略。
BACKGROUND: Understanding surgical site infection (SSI) risk factors after breast operation is essential to develop infection-prevention strategies and improve surgical outcomes.METHODS: We performed a retrospective case-control study with subjects selected from a cohort of mastectomy, breast reconstruction, and reduction surgical patients between January 1998 and June 2002 at a university-affiliated hospital. SSI cases within 1 year after operation were identified using ICD9-CM diagnosis codes for wound infection and complication or positive wound cultures, or both. Medical records of 57 patients with breast SSI and 268 randomly selected uninfected control patients were reviewed. Multivariate logistic regression was used to identify independent risk factors for SSI.RESULTS: Significant independent risk factors for breast incisional SSI included insertion of a breast implant or tissue expander (odds ratio [OR] = 5.3; 95% CI, 2.5 to 11.1), suboptimal prophylactic antibiotic dosing (OR = 5.1; 9 5% CI, 2.5 to 10.2), transfusion (OR = 3.4; 95% CI, 1.3 to 9.0), mastectomy (OR = 3.3; 95% CI, 1.4 to 7.7), previous chest irradiation (OR = 2.8; 95% CI, 1.2 to 6.5), and current or recent smoking (OR = 2.1; 95% CI, 0.9 to 4.9). Local infiltration of an anesthetic agent was associated with substantially reduced odds of SSI (OR 0.4; 95% CI, 0.1 to 0.9).CONCLUSIONS: Suboptimal prophylactic antibiotic dosing is a potentially modifiable risk factor for SSI after breast operation. SSI risk was increased in patients undergoing mastectomy and in patients who had an implant or tissue expander placed during operation. This information can be used to develop a specific risk stratification index to predict SSI and infection-preventive strategies tailored for breast surgery patients.