Surgical Site Infection and Colorectal Surgical Procedures: A Prospective Analysis of Risk Factors
Surgical Site Infection and Colorectal Surgical Procedures: A Prospective Analysis of Risk Factors
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DOI：
10.1089/sur.2016.258
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发表时间：
2017-05-01
影响因子：
2
通讯作者：
Mahmoud, Najjia
中科院分区：
文献类型：
--
作者：
Paulson, E. Carter;Thompson, Earl;Mahmoud, Najjia
背景：在择期手术中，结直肠外科手术（CRS）的手术部位感染（SSI）率最高。广泛的患者和手术特征已被确定为SSI的风险因素。大多数研究受到依赖回顾性数据或包括CRS的数据子集分析的限制。这项研究反映了SSI的风险因素分析，使用前瞻性收集的数据在一个选修CRS population.Patients和方法：我们分析了前瞻性收集的数据，作为一个随机的一部分，盲法皮肤抗菌试验在选修CRS，以确定与SSI相关的风险因素，包括浅表或深部SSI或蜂窝织炎出院后30天内。使用照片记录、患者问卷调查和主治外科医生的盲态审查来识别SSI。多变量logistic回归被用来识别与SSI显著相关的因素，并计算预测风险的SSI.Results：从2011年至2015年，787例患者接受清洁污染的程序，由结直肠外科医生进行了分析，作为随机临床试验的一部分。总体SSI发生率为21.5%。四个变量-切口长度，手术指征，体重指数和手术方法-与SSI显著相关。根据这四个变量，SSI的预测风险范围为60%。结论：本研究是最大的前瞻性研究，SSI在选择性CRS。根据可修改和不可修改的因素，CRS后的SSI风险范围非常广泛。识别那些处于风险极端的人可能有助于我们识别和减轻感染的贡献者。
Background: Colorectal surgical procedures (CRS) are associated with the highest surgical site infection (SSI) rate among elective operations. A wide range of patient and surgical characteristics have been identified as risk factors for SSI. Most studies are limited by reliance on retrospective data or subset analysis of data that includes CRS. This study reflects analysis of SSI risk factors using prospectively collected data in an elective CRS population.Patients and Methods: We analyzed data prospectively collected as part of a randomized, blinded trial of skin anti-sepsis in elective CRS to identify risk factors associated with SSI, including superficial or deep SSI or cellulitis within 30 days post-discharge. Photodocumentation, patient questionnaires, and blinded review by an attending surgeon were used to identify SSI. Multi-variable logistic regression was used to identify factors significantly associated with SSI and to calculate predicted risks of SSI.Results: From 2011 to 2015, 787 patients undergoing clean-contaminated procedures by colorectal surgeons were analyzed as part of a randomized clinical trial. The overall SSI rate was 21.5%. Four variables-incision length, surgical indication, body mass index, and surgical approach-were significantly associated with SSI. Based on these four variables, the predicted risk of SSI ranges from 60%.Conclusion: This study represents the largest prospective investigation of SSI in elective CRS. There is a very wide range of SSI risk after CRS based on both modifiable and non-modifiable factors. Identification of those at the extreme ends of risk may help us both identify and mitigate contributors to infection.