American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update
American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update
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DOI：
10.1016/j.jamcollsurg.2016.10.029
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发表时间：
2017-01-01
影响因子：
5.2
通讯作者：
Duane, Therese M.
中科院分区：
文献类型：
--
作者：
Ban, Kristen A.;Minei, Joseph P.;Duane, Therese M.
之前已经发布了手术部位感染（SSI）的预防、检测和管理指南。1-3本文件旨在根据现有文献更新早期指南，并提供相关主题的简明摘要。手术部位感染既常见又病态。手术部位感染现在是所有医院获得性感染中最常见和最昂贵的，占所有医院获得性感染的20%。手术部位感染与住院时间延长和死亡风险增加2- 11倍相关。虽然大多数患者从SSI中恢复而没有长期不良后遗症，但SSI患者77%的死亡率可归因于感染本身。1，4在接受住院手术的患者中，SSI的发生率为2%至5%。1估计的年发病率差异很大，在美国从16万到30万不等。1，4考虑到出院后的监测挑战，这些估计可能被低估了。SSI的经济负担是相当大的;它是医院获得性感染中最昂贵的。1美国SSI的年度成本估计为35亿至100亿美元。1 SSI的成本增加是由于住院时间、急诊就诊和再入院的增加。平均而言，SSI延长了住院时间9.7天，并增加了每次入院超过20，000美元的住院费用。每年有超过90，000例重新入院归因于SSI，每年额外花费7亿美元。由于估计高达60%的SSI可以通过使用循证措施来预防，1 SSI已成为按绩效付费的指标和质量改进工作的目标。
Guidelines for the prevention, detection, and management of surgical site infections (SSI) have been published previously. 1-3 This document is intended to update earlier guidelines based on the current literature and to provide a concise summary of relevant topics. Surgical site infections are both common and morbid. Surgical site infections are now the most common and costly of all hospital-acquired infections, accounting for 20% of all hospital-acquired infections. Surgical site infections are associated with increased length of stay and a 2-to 11-fold increase in the risk of mortality. Although most patients recover from an SSI without long-term adverse sequelae, 77% of mortality in patients with an SSI can be attributed to the infection itself. 1, 4The incidence of SSI is 2% to 5% in patients undergoing inpatient surgery. 1 Estimated annual incidence varies widely, ranging from 160,000 to 300,000 in the US. 1, 4 These estimates are likely understated, given the surveillance challenges after discharge. The financial burden of SSI is considerable; it ranks as the most costly of the hospital-acquired infections. 1 The annual cost of SSI in the US is estimated at $3.5 to $10 billion. 1 Increased costs from SSIs are driven by increased length of stay, emergency department visits, and readmissions. On average, SSI extends hospital length of stay by 9.7 days, and increases the cost of hospitalization by more than $20,000 per admission. More than 90,000 readmissions annually are attributed to SSIs, costing an additional $700 million per year. Because up to 60% of SSIs were estimated to be preventable with the use of evidence-based measures, 1 SSI has become a pay-for-performance metric and a target of qualityimprovement efforts.