Wound infection after elective colorectal resection
Wound infection after elective colorectal resection
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DOI：
10.1097/01.sla.0000124292.21605.99
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发表时间：
2004-05-01
影响因子：
9
通讯作者：
Foley, EF
中科院分区：
文献类型：
--
作者：
Smith, RL;Bohl, JK;Foley, EF
引言：手术部位感染（SSI）是结直肠切除术后一种潜在的病态和昂贵的并发症。近年来越来越多的注意力放在准确识别和监测这种手术并发症及其成本上。从增加的患者发病率和增加的社会经济成本来衡量。我们假设，切口SSI择期结直肠切除术后更频繁，比一般在文献中报道的，他们可以预测可测量的围手术期因素，他们携带大量的发病率和cost.Methods：在2年的时间内，在一所大学医院，所有的数据进行了回顾性收集由一个单一的外科医生进行择期结直肠切除术。关注的结局是疾病控制和预防中心定义的切口SSI诊断。收集文献或专家确定的与感染相关的变量，并分析其与该患者队列中切口SSI发生的相关性。然后通过逐步logistic回归对与切口SSI相关的变量进行多变量分析，通过单变量分析确定其预后意义。将本研究中SSI的发生率与文献中报告的该患者人群中切口SSI的发生率进行比较，并通过基于国家的医院感染监测系统进行预测，并在我们机构前瞻性获取的部门内外科感染数据库中进行描述。结果：176例接受择期结直肠切除术的患者被确定为评估。患者平均年龄为62 ± 1.2岁。54%是男性。术前诊断包括结直肠癌（57%）、炎症性肠病（20%）、憩室炎（10%）和良性息肉病（5%）。在45例患者（26%）中确定了SSI。出院后在门诊环境中检测到22例（49%）SSI。在测量的所有术前和围手术期变量中，患者体重指数增加和术中低血压独立预测切口SSI。虽然我们无法测量与SSI相关的住院时间的统计学增加，但SSI患者的代表性人群累积了与伤口护理相关的平均6200美元/患者的家庭健康费用。我们的SSI发生率显著高于文献中的一般报告、国家医院感染系统的预测或我们自己的机构外科感染数据库的描述。结论：在我们的队列中，接受择期结直肠切除术的患者的切口SSI发生率显著高于文献、NNIS或机构外科感染并发症登记研究的预测值。虽然其中一些差异可能归因于患者人群差异，但我们认为这些差异突出了独立于初级临床护理团队的系统性结局测量工具的潜在局限性。初级临床团队准确的手术并发症记录对于确定手术并发症（如切口SSI）的真实频率和病因，合理减少手术并发症并降低患者和医疗保健系统的相关成本至关重要。
Introduction: Surgical site infection (SSI) is a potentially morbid and costly complication following major colorectal resection. In recent years. there has been growing attention placed on the accurate identification and monitoring of such surgical complications and their costs. measured in terms of increased morbidity to patients and increased financial costs to society. We hypothesize that incisional SSIs following elective colorectal resection are more frequent than is generally reported in the literature, that they can be predicated by measurable perioperative factors, and that they carry substantial morbidity and cost.Methods: Over a 2-year period at a university hospital, data on all elective colorectal resections performed by a single surgeon were retrospectively collected. The outcome of interest was a diagnosis of incisional SSI as defined by the Center of Disease Control and Prevention. Variables associated with infection, as identified in the literature or by experts, were collected and analyzed for their association with incisional SSI development in this patient cohort. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI by univar-iate analysis to determine their prognostic significance. The incidence of SSI in this study was compared with the rates of incisional SSI in this patient population reported in the literature, predicted by a nationally based system monitoring nosocomial infection, and described in a prospectively acquired intradepartmental surgical infection data base at our institution. Results: One hundred seventy-six patients undergoing elective colorectal resection were identified for evaluation. The mean patient age was 62 +/- 1.2 years. and 54% were men. Preoperative diagnoses included colorectal cancer (57%), inflammatory bowel disease (20%), diverticulitis (10%), and benign polyp disease (5%). SSIs were identified in 45 patients (26%). Twenty-two (49%) SSIs were detected in the outpatient setting following discharge. Of all preoperative and perioperative variables measured, increasing patient body mass index and intraoperative hypotension independently predicted incisional SSI. Although we could not measure statistically increased length of hospital stay associated with SSI, a representative population of patients with SSI accumulated a mean of $6200/patient of home health expenses related to wound care. Our rates of SSI were substantially higher than that reported generally in the literature, predicted by the National Nosocomial Infection System, or described by our own institutional surgical infection data base. Conclusions: The incidence of incisional SSI in patients undergoing elective colorectal resection in our cohort was substantially higher than generally reported in the literature, the NNIS or predicted by an institutional surgical infection complication registry. Although some of these differences may be attributable to patient population differences, we believe these discrepancies highlight the potential limitations of systematic outcomes measurement tools which are independent of the primary clinical care team. Accurate surgical complication documentation by the primary clinical team is critical to identify the true frequency and etiology of surgical complications such as incisional SSI, to rationally approach their reduction and decrease their associated costs to patients and the health care system.