Associated factors with surgical site infections after hepatectomy: Predictions and countermeasures by a retrospective cohort study
Associated factors with surgical site infections after hepatectomy: Predictions and countermeasures by a retrospective cohort study
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DOI：
10.1016/j.ijsu.2014.01.018
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发表时间：
2014-01-01
影响因子：
15.3
通讯作者：
Nagayasu, Takeshi
中科院分区：
文献类型：
--
作者：
Nanashima, Atsushi;Arai, Junichi;Nagayasu, Takeshi
背景资料：为了阐明与肝切除术后手术部位感染（SSI）相关的因素，对526例接受肝切除术的患者的临床病理资料进行回顾性队列研究。方法：比较非SSI组和SSI组的患者人口统计学资料、肝功能、组织学检查结果、手术记录和肝切除术后发病率; SSI组包括浅表和深部SSI。SSI的患病率（5-8%）在18年内没有变化。在体能状态和美国麻醉医师协会（阿萨）评分较低的男性患者中，深部SSI显著增加（p < 0.05）。与接受开腹手术的患者相比，接受腹腔镜肝切除术的患者中SSI的发生率往往较低，但不显著（p = 0.10）。对于使用止血器械的患者，浅表SSI的患病率显著低于未使用器械的患者（p < 0.05）。与其他组相比，深部SSI组的失血和输血明显更频繁（p < 0.01）。深度SSI组的住院时间显著长于其他组。与非SSI组相比，SSI组的发病率更高（p < 0.001）。多变量分析显示，不使用血管闭合装置与浅表SSI显著相关;男性、肝衰竭和胆漏与深部SSI显著相关（p < 0.05）。结论：SSI是肝切除术后患者结局的重要指标，预防手术后SSI发展是提高SSI总体患病率的重要步骤。(C)2014 Surgical Associates Ltd.由Elsevier Ltd.发布。保留所有权利。
Background: To clarify the factors associated with post-hepatectomy surgical site infections (SSIs), the clinicopathological data of 526 patients who underwent hepatectomy was retrospectively examined as a retrospectively cohort study.Methods: Patient demographics, liver functions, histological findings, surgical records and post-hepatectomy morbidity were compared between non-SSI and SSI groups; the SSI group included superficial and deep SSIs.Results: The prevalence of SSIs (5-8%) has not changed over an 18-year period. Deep SSIs were significantly more increased in male patients with lower performance statuses and American Society of Anesthesiologists (ASA) scores (p < 0.05). SSIs tended to be less prevalent, although not significant (p = 0.10), in patients who underwent laparoscopic hepatectomies compared to those who underwent laparotomies. For patients in whom hemostatic devices were used, the prevalence of superficial SSIs was significantly lower than those in whom the devices were not used (p < 0.05). Blood loss and transfusion were significantly more frequent in the deep SSI group compared to other groups (p < 0.01). Hospital stay in the deep SSI group was significantly longer compared to other groups. The incidence of morbidity was more frequent in the SSI groups compared with the non-SSI group (p < 0.001). A multivariate analysis showed that not using a vessel sealing device was significantly associated with superficial SSIs; male gender, hepatic failure and bile leakage were significantly associated with deep SSIs (p < 0.05).Conclusions: SSIs were important indicators of patient outcomes after hepatectomies, and preventing SSI development after surgical procedures is an important step in improving the overall prevalence of SSIs. (C) 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.