An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery
An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery
复制标题
DOI：
10.1016/j.surg.2014.05.010
复制
发表时间：
2014-11-01
期刊：
影响因子：
3.8
通讯作者：
Bilimoria, Karl
中科院分区：
文献类型：
--
作者：
Segal, Cynthia G.;Waller, Dorothy K.;Bilimoria, Karl
背景资料。大多数研究和国家计划汇总了不同类型的手术部位感染(SSI)，潜在地掩盖和错误分配了风险。确定浅部、深部和器官间隙SSI的危险因素是唯一的，这对于提高SSI的发生率至关重要。这项队列研究使用了2007至2009年间在参与美国外科医师学会国家外科质量改进计划的医院接受结肠切除的59,365名患者的数据。建立了四个独立的、多变量的预测模型，以评估危险因素与每个SSI组之间的独特关联：浅层、深层、器官间隙和所有三种类型SSI的集合。总体而言，13%的结肠病例出现SSI：浅表(8%)、深部(1.4%)和器官间隙(3.8%)。每个型号都是不同的。在所有模型中，病态肥胖患者比正常体重患者更有可能发生SSIS；然而，所有模型共有的风险因素(例如，身体质量指数[BMI]、手术持续时间、伤口类别、腹腔镜手术)具有非常不同的风险水平。浅表SSI的独特风险包括糖尿病、慢性阻塞性肺疾病和呼吸困难。深度SSI与BMI的关联度最大，伤口裂开的发生率最高(19.8%)。器官间隙SSI通常是由吻合口漏引起的，与播散性癌症、术前透析、术前放射治疗和出血性疾病有关，这表明虚弱或虚弱的患者可能会使吻合口处于危险之中。浅间隙、深间隙和器官间隙SSI的危险因素不同。通过单独报告和检查每种类型的SSI，可以制定更有效的预防策略。
Background. Most studies and national programs aggregate the different types of surgical site infections (SSIs) potentially masking and misattributing risk. Determining that risk factors for superficial, deep, and organ space SSIs are unique is essential to improve SSI rates.Methods. This cohort study utilized data of 59,365 patients who underwent colon resection at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2007 to 2009. Four independent, multivariable, predictive models were developed to assess the unique associations between risk factors and each SSI group: Superficial, deep, organ space, and an aggregate of all 3 types of SSIs.Results. Overall, 13% of colon cases developed SSIs: Superficial (8%), deep (1.4%), and organ space (3.8%). Each model was different. Morbidly obese patients were more likely to develop SSIs than normal weight patients across all models; however, risk factors common to all models (eg, body mass index [BMI], duration of operation, wound class, laparoscopic approach) had very different levels of risk. Unique risks for superficial SSIs include diabetes, chronic obstructive pulmonary disease, and dyspnea. Deep SSIs had the greatest magnitude of association with BMI and the greatest incidence of wound disruption (19.8%). Organ space SSIs were often owing to anastomotic leaks and were uniquely associated with disseminated cancer, preoperative dialysis, preoperative radiation treatment, and a bleeding disorder, suggesting a physically frail or compromised patient may put the anastomosis at risk.Conclusion. Risk factors for superficial, deep, and organ space SSI differ. More effective prevention strategies may be developed by reporting and examining each type of SSI separately.