Reportable infections following colon surgery in a large public healthcare system in New York City: The consequences of being a level 1 trauma center.
Reportable infections following colon surgery in a large public healthcare system in New York City: The consequences of being a level 1 trauma center.
复制标题
纽约市大型公共医疗系统中结肠手术后报告的感染：成为 1 级创伤中心的后果。
DOI：
10.1017/ice.2023.150
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发表时间：
2024
影响因子：
4.5
通讯作者：
Quale,John
中科院分区：
文献类型：
--
作者：
Fornek,MaryL;Ata,Subhan;Jimenez,Edwin;Abdallah,Marie;Sunny,Subin;Lee,Jennifer;Episcopia,Briana;Roudnitsky,Valery;Quale,John
目的比较在1级创伤中心和其他医院接受结肠手术的患者的危险因素和结果的差异，并调查这些可报告感染的潜在财务影响。设计在2015至2020年间进行的回顾队列研究。在纽约市建立大型公共医疗系统。参与者所有接受结肠手术的患者；(1)所有在1级创伤中心接受结肠手术的患者与其他医院的患者进行比较；(2)1级创伤中心的非创伤和创伤患者与其他医院的非创伤患者进行比较。结果在报告的5,217例结肠手术中，3,531例在1级创伤中心，1686例在其他医院。与其他医院相比，一级创伤中心的患者显著增加了美国麻醉学会(ASA)评分、手术持续时间、伤口延迟闭合率和4级创伤率，导致更高的SIRS(1.1±0.15比0.75±0.18；P=.0007)。与其他医院的非创伤患者相比，一级创伤中心的非创伤患者和创伤患者的ASA评分、伤口延迟闭合率和4类伤口的发生率都较高。一级创伤中心非创伤患者的SIRS(1.16±1.29；P=0.008)和创伤患者的SIRS(1.26±2.69；P=0.066)高于其他医院非创伤患者的SIRS(0.65±1.18)。在对这些危险因素进行适当调整之前，应重新评估结肠手术后感染作为可报告的质量指标的使用情况。
ObjectivesTo examine differences in risk factors and outcomes of patients undergoing colon surgery in level 1 trauma centers versus other hospitals and to investigate the potential financial impact of these reportable infections.DesignRetrospective cohort study between 2015 and 2022.SettingLarge public healthcare system in New York City.ParticipantsAll patients undergoing colon surgery; comparisons were made between (1) all patients undergoing colon surgery at the level 1 trauma centers versus patients at the other hospitals and (2) the nontrauma and trauma patients at the level 1 trauma centers versus the nontrauma patients at other hospitals.ResultsOf 5,217 colon surgeries reported, 3,531 were at level 1 trauma centers and 1686 at other hospitals. Patients at level 1 trauma centers had significantly increased American Society of Anesthesiology (ASA) scores, durations of surgery, rates of delayed wound closure, and rates of class 4 wounds, resulting in higher SIRs (1.1 ± 0.15 vs 0.75 ± 0.18; P = .0007) compared to the other hospitals. Compared to the nontrauma patients at the other hospitals, both the nontrauma and trauma patients at the level 1 trauma centers had higher ASA scores, rates of delayed wound closure, and of class 4 wounds. The SIRs of the nontrauma patients (1.16 ± 1.29; P = .008) and trauma patients (1.26 ± 2.69; P = .066) at the level 1 trauma center were higher than the SIRs of nontrauma patients in the other hospitals (0.65 ± 1.18).ConclusionsPatients undergoing colon surgery at level 1 trauma centers had increased complexity of surgery compared to the patients in other hospitals. Until there is appropriate adjustment for these risk factors, the use of infections following colon surgery as a reportable quality measure should be re-evaluated.