Antibiotic Choice Is Independently Associated With Risk of Surgical Site Infection After Colectomy A Population-Based Cohort Study
Antibiotic Choice Is Independently Associated With Risk of Surgical Site Infection After Colectomy A Population-Based Cohort Study
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DOI：
10.1097/sla.0b013e31826c4009
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发表时间：
2013-03-01
影响因子：
9
通讯作者：
Campbell, Darrell A., Jr.
中科院分区：
文献类型：
--
作者：
Hendren, Samantha;Fritze, Danielle;Campbell, Darrell A., Jr.
目的：确定哪些围手术期护理措施与降低结肠切除术后手术部位感染(SSI)风险相关。背景：优化围手术期护理一直是提高手术安全性的常见策略，但过程措施遵从性与手术并发症发生率之间的关系存在争议。方法：这是一项在密歇根外科质量合作组织(MSQC)内进行的回顾性队列研究，MSQC是一个医院组织，前瞻性地收集患者数据、护理过程和30天的结果。研究对象为4331例接受结肠切除术的患者。结果：在调整了患者风险、手术类型/持续时间和医院内患者的聚集性后，几种围手术期护理做法独立地与SSI的风险降低相关。最佳实践包括选择符合外科护理改善项目(SCIP-2)的预防性静脉注射抗生素、术后常温、术后第一天血糖控制以及在肠道准备时使用口服抗生素(SCIP-1不重要)。此外，几种特定的预防性抗生素选择独立地与较低的SSI发生率相关，包括头孢唑林/甲硝唑、环丙沙星/甲硝唑和厄他培南。结论：在密歇根州，几种围手术期护理措施与降低结肠切除术后SSI的风险独立相关，包括符合SCIP-2的预防性抗生素、术后常温、血糖控制和口服抗生素。此外，特定的预防性抗生素选择与SSI的风险较低相关。这些结果解释了患者因素和未测量的医院影响，表明推广这些围手术期护理做法可能会降低SSI发生率。
Objective: To determine which perioperative care practices are associated with decreased risk of surgical site infection (SSI) after colectomy surgery.Background: Optimization of perioperative care has been a common strategy for improving surgical safety, but the relationship between process measure compliance and surgical complication rates is controversial.Methods: This is a retrospective cohort study performed within the Michigan Surgical Quality Collaborative (MSQC), an organization of hospitals that prospectively collects patient data, processes of care, and 30-day outcomes. Patients undergoing colectomy surgery (n = 4331) were studied. Factors potentially associated with SSI were tested using univariate statistical tests, and a hierarchical generalized linear model was created to test for independent associations between processes of care and SSI, while adjusting for patient risk factors and clustering of patients within hospitals.Results: Several perioperative care practices were independently associated with lower risk of SSI after adjustment for patient risk, procedure type/duration, and clustering of patients by hospital site. Best practices include selection of a Surgical Care Improvement Project (SCIP-2)-compliant prophylactic intravenous antibiotic, postoperative normothermia, postoperative day 1 glucose control, and oral antibiotics given when bowel prep used (SCIP-1 was not significant). Further, several specific prophylactic antibiotic choices were independently associated with lower SSI rates, including cefazolin/metronidazole, ciprofloxacin/metronidazole, and ertapenem.Conclusions: In Michigan, several perioperative care practices are independently associated with decreased risk of SSI after colectomy, including SCIP-2-compliant prophylactic antibiotics, postoperative normothermia, glucose control, and oral antibiotics. Furthermore, specific prophylactic antibiotic choices are associated with lower risk of SSI. These results account for patient factors and unmeasured hospital effects, suggesting that dissemination of these perioperative care practices may decrease SSI rates.