Risk factors for postoperative infectious complications in noncolorectal abdominal surgery - A multivariate analysis based on a prospective multicenter study of 4718 patients
Risk factors for postoperative infectious complications in noncolorectal abdominal surgery - A multivariate analysis based on a prospective multicenter study of 4718 patients
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DOI：
10.1001/archsurg.138.3.314
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发表时间：
2003-03-01
影响因子：
--
通讯作者：
Flamant, Y
中科院分区：
文献类型：
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作者：
Pessaux, P;Msika, S;Flamant, Y
假设：感染性并发症是腹部外科术后并发症的主要原因。识别围手术期可以避免的危险因素，可能会降低术后感染并发症的发生率。设计：从3项前瞻性、随机、多中心研究中建立数据库。采用非条件Logistic回归进行多因素分析，以优势比(OR)表示。设置：多中心研究(即私立医疗中心、机构医院和大学医院)。患者：1982年6月至1996年9月，建立了包含4718例非结直肠外科手术患者信息的数据库。主要观察指标：因变量包括手术部位感染(分为有或无瘘管的壁部和深层感染并发症)和全球感染并发症(SSI和顶外及腹部感染并发症)。结果：全球感染并发症发生率为13.3%；SSI为4.05%。感染性并发症2.2%，深部感染性并发症伴瘘2.18%，深部无瘘感染性并发症1.38%。在多因素分析中，确定了以下7个全球感染并发症的独立危险因素：年龄(60-74岁，OR1.64；大于或等于75岁，OR1.45)；体重过轻(OR1.51)；有肝硬变(OR2.45)，腹部垂直切开(OR1.66)；在消化道内放置肠缝或吻合口(OR1.48)；手术时间延长(61120分钟，OR1.66；121min，OR2.72)；并被归类为有4个4类手术部位(即肥胖患者或有愈合缺陷的危险因素)(OR，1.66)。头孢曲松钠治疗被确定为保护因素(OR，0.43)。在多因素分析中，以下5个独立危险因素被确定为SSI的危险因素：术前存在皮肤脓肿或皮肤坏死(OR，4.75)，在消化道内放置缝线或吻合肠(OR，1.82)，术后有腹部引流(OR，2.15)，接受癌症手术(OR，1.74)，以及术后接受根治性抗凝治疗(OR，3.33)。事实上，只有缝线的位置或进行了肛门失禁。消化道的肠道造口是SSI和全球感染的危险因素。离子。这些因素中的一些可以在手术前或手术中改变，以降低感染率或预防术后并发症。
Hypothesis: Infectious complications are the main causes of postoperative morbidity in abdominal surgery. Identification of risk factors, which could be avoided in the perioperative period, may reduce the rate of postoperative infectious complications.Design: A database was established from 3 prospective, randomized, multicenter studies. Multivariate analysis was performed using nonconditional logistic regression expressed as an odds ratio (OR).Setting: Multicenter studies (ie, private medical centers, institutional hospitals, and university hospitals).Patients,: From June 1982 to September 1996, a database was established containing the information of 4718 patients who underwent noncolorectal abdominal surgery.Main Outcome Measures: The dependent variables studied included surgical site infection (SSI) (divided into parietal and deep infectious complication's with or without fistulas) and global infectious complications (SSI and extraparietal and Abdominal infectious complications).Results: The rate of global infectious complications was 13.3%; SSI, 4.05%.; parietal. infectious complications, 2.2%; deep infectious complications with fistulas, 2.18%; and deep, infectious complications without fistulas, 1.38%. In multivariate analysis, the following 7 independent risk factors for global infectious complications have been identified: Age (60-74 years, OR, 1.64; greater than or equal to75 years, OR, 1.45); being underweight (OR, 1.51); having cirrhosis (OR, 2.45), having a vertical abdominal incision (OR, 1.66); having a suture placed or an anastomis of the bowel (OR, 1.48) in the digestive tract; having a prolonged operative time (61120 minutes, OR, 1.66; 121 minutes, OR, 2.72); and being categorized as having 4 class 4 surgical site (ie, obese patients or having a risk factor of a healing defect) (OR, 1.66). Ceftriaxone sodium therapy was identified as a protective factor (OR, 0.43). In multivariate analysis, the following 5 independent risk factors for SSI have been identified: the existence of a preoperative cutaneous abscess or cutaneous necrosis (OR, 4.75), having a suture placed or an anastomosis of the bowel (OR, 1.82) in the digestive tract, having postoperative abdominal drainage (OR, 2.15), undergoing a surgicial procedure for the treatment of cancer (OR, 1.74), And receiving curative anticoagulant therapy (OR, 3.33) postoperatively.Conclusions: Our data show that risk factors for SSI and for global infectious complications are disparate. Indeed, only the placement of a suture or having an ana. stomosis of the bowel in the digestive tract is a risk factor for both SSI and global infect. ions. I Some of these factors may be modifiable before or during the surgical procedure to reduce the infection rate or to prevent postoperative complications.