Postoperative hypothermia and surgical site infection following peritoneal insufflation with warm, humidified carbon dioxide during laparoscopic colorectal surgery: a cohort study with cost-effectiveness analysis.
Postoperative hypothermia and surgical site infection following peritoneal insufflation with warm, humidified carbon dioxide during laparoscopic colorectal surgery: a cohort study with cost-effectiveness analysis.
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DOI：
10.1007/s00464-016-5195-0
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发表时间：
2017-04
期刊：
影响因子：
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通讯作者：
Arulampalam TH
中科院分区：
文献类型：
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作者：
Mason SE;Kinross JM;Hendricks J;Arulampalam TH
9%的腹腔镜结直肠手术发生手术部位感染（SSI）。用于腹膜吹入的加温和二氧化碳（CO2）可通过避免术后体温过低（本身是SSI的风险因素）来预防SSI。本研究旨在评估CO2调节对术后低温和SSI的影响，并进行成本效益分析。在英国一家专科中心对接受择期腹腔镜结直肠切除术的患者进行了一项回顾性队列研究。对照组（n = 123）接受室温、干燥CO2的腹膜吹入，而干预组（n = 123）接受温暖、潮湿的CO2（使用HumiGard™，Fisher & Paykel Healthcare）。结果为术后低体温、SSI和费用。进行多变量分析。共有246名患者被纳入研究。平均年龄为68（20-87），平均BMI为28（15-51）。主要诊断为癌症（n = 173），两组之间无基线差异。CO2预处理显著降低了术后体温过低的发生率（比值比0.10，95% CI 0.04-0.23），发现体温过低患者的SSI风险增加（比值比4.0，95% CI 1.25-12.9）。使用条件CO2显著降低SSI的发生率66%（p = 0.04）。干预组每位患者的费用减少了155英镑。增量成本效益比为负数。 腹腔镜结直肠手术中的CO2调节是一种安全、可行且具有成本效益的干预措施。它提高了与SSI和术后低体温相关的手术护理质量。
Surgical Site Infection (SSI) occurs in 9 % of laparoscopic colorectal surgery. Warming and humidifying carbon dioxide (CO2) used for peritoneal insufflation may protect against SSI by avoiding postoperative hypothermia (itself a risk factor for SSI). This study aimed to assess the impact of CO2 conditioning on postoperative hypothermia and SSI and to perform a cost-effectiveness analysis. A retrospective cohort study of patients undergoing elective laparoscopic colorectal resection was performed at a single UK specialist centre. The control group (n = 123) received peritoneal insufflation with room temperature, dry CO2, whereas the intervention group (n = 123) received warm, humidified CO2 (using HumiGard™, Fisher & Paykel Healthcare). The outcomes were postoperative hypothermia, SSI and costs. Multivariate analysis was performed. A total of 246 patients were included in the study. The mean age was 68 (20–87) and mean BMI 28 (15–51). The primary diagnosis was cancer (n = 173), and there were no baseline differences between the groups. CO2 conditioning significantly decreased the incidence of postoperative hypothermia (odds ratio 0.10, 95 % CI 0.04–0.23), with hypothermic patients found to be at increased risk of SSI (odds ratio 4.0, 95 % CI 1.25–12.9). Use of conditioned CO2 significantly decreased the incidence of SSI by 66 % (p = 0.04). The intervention group incurred costs of £155 less per patient. The incremental cost-effectiveness ratio was negative. CO2 conditioning during laparoscopic colorectal surgery is a safe, feasible and a cost-effective intervention. It improves the quality of surgical care relating to SSI and postoperative hypothermia.