Adverse impact of surgical site infections in English hospitals
Adverse impact of surgical site infections in English hospitals
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DOI：
10.1016/j.jhin.2004.10.019
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发表时间：
2005-06-01
影响因子：
6.9
通讯作者：
Borriello, P
中科院分区：
文献类型：
--
作者：
Coello, R;Charlett, A;Borriello, P
在1997年10月至2001年6月期间，140家英国医院参与了医院感染国家监测局（NINSS）的手术部位感染监测，报告了在9种确定的手术类别中67410例手术后发生的2532例手术部位感染。断肢手术的SSI发生率最高，为14.3例/ 100例。除膝关节假体（P=0.128）外，所有手术类别的SSI发生率随美国国家医院感染监测风险指数的增加呈线性增加。肤浅的切口。SSI较深切口多见。器官/空间SSI，占所有手术类别中所有SSI的一半以上。SSI患者的术后住院时间（LOS）更长，在考虑其他影响LOS的因素后，SSI导致的额外住院时间从腹式子宫切除术的3.3天到肢体截肢的21.0天不等，其他类别患者至少为9天。可归因于SSI的额外费用从腹部子宫切除术的959英镑到肢体截肢的6103英镑不等。深深的切口。与表面切口相比，器官/空间SSI合并造成了更大的额外LOS和成本。所有的SSI。手术类别，肢体截肢除外。在所有手术类别中，SSI患者的粗死亡率都较高，但在控制混杂因素后，只有髋关节假体术后SSI患者的死亡率显著高于未行SSI的患者[比值比(OR) = 1.8， P=0.002]。然而，在血管手术（OR=6.8, P < 0.001）、髋关节假体（OR=2.5， P=0.005）和大肠手术（OR= 1.8， P=0.04）中，深切口和器官/间隙SSI患者的调整死亡率明显高于无SSI患者。本研究表明，不同手术类别的SSI的不良影响差异很大，并强调了测量定义类别的影响的重要性，而不是测量所有SSI和所有手术程序的影响。(c) 2004年，医院感染学会。Elsevier Ltd.出版。版权所有。
Between October 1997 and June 2001, 140 English hospitals participating in the surveillance of surgical site infection (SSI) with the Nosocomial Infection National Surveillance Service (NINSS) reported 2532 SSIs following 67410 surgical procedures in nine defined categories of surgery. Limb amputation had the highest incidence of SSI with 14.3 SSIs per 100 operations. For all categories of surgery, except knee prosthesis (P=0.128), there was a linear increase in the incidence of SSI when the American National Nosocomial Infections Surveillance risk index increased. Superficial incisional. SSI was more common than deep incisional. and organ/space SSI, and accounted for more than half of all SSIs for all categories of surgery. The postoperative length of stay (LOS) was longer for patients with SSI, and when adjusted for other factors influencing LOS, the extra LOS due to SSI ranged from 3.3 days for abdominal hysterectomy to 21.0 days for limb amputation, and was at least nine days for the other categories. The additional cost attributable to SSI ranged from 959 pound for abdominal hysterectomy to 6103 pound for limb amputation. Deep incisional. and organ/space SSI combined incurred a greater extra LOS and cost than superficial incisional. SSI for all. categories of surgery, except limb amputation. The crude mortality rate was higher for patients with SSI for all categories of surgery but, after controlling for confounding, only patients with SSI following hip prosthesis had a mortality rate that was significantly higher than those without SSI [odds ratio (OR) = 1.8, P=0.002]. However, the adjusted mortality rate for patients with deep incisional and organ/space SSI compared with those without SSI was significantly higher for vascular surgery (OR=6.8, P < 0.001), hip prosthesis (OR=2.5, P=0.005) and large bowel surgery (OR= 1.8, P=0.04). This study shows that the adverse impact of SSI differs greatly for different categories of surgery, and highlights the importance of measuring the impact for defined categories rather than for all SSIs and all surgical procedures. (c) 2004 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.