Impact of Delayed Chest Closure on Surgical Site Infection After Lung Transplantation
Impact of Delayed Chest Closure on Surgical Site Infection After Lung Transplantation
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DOI：
10.1016/j.athoracsur.2017.05.023
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发表时间：
2017-10-01
影响因子：
4.6
通讯作者：
Hachem, Ramsey R.
中科院分区：
文献类型：
--
作者：
Aguilar, Patrick R.;Bemiss, Bradford C.;Hachem, Ramsey R.
背景资料。延迟关闭胸腔是治疗肺移植后出血和血流动力学不稳定的一种越来越常用的方法。我们试图评估延迟关胸对手术部位感染的影响。我们进行了一项单中心回顾性队列研究，纳入了2010年1月1日至2014年7月31日期间在我们中心接受肺移植的成年患者。我们将手术部位感染定义为开胸手术伤口或胸腔感染。术后6个月完成随访。我们使用Logistic回归模型来检验延迟关胸对手术部位感染的影响，并找出其他潜在的危险因素。在研究期间，232例移植手术中有67例(29%)需要延迟关胸，22例受者(9%)发生了手术部位感染。手术部位感染中，伤口感染18例，胸腔感染8例，合并伤口和胸腔感染4例。在67名延迟关闭胸腔的患者中，13名患者(19%)发生了手术部位感染，相比之下，接受一期关闭手术的患者中有9名患者(5%)(p=0.001)。在多因素分析中，延迟关胸是手术部位感染的独立危险因素。虽然延迟关闭胸腔可能在肺移植受者的即时处理中起到重要作用，但它是手术部位感染的独立危险因素，这与发病率的增加有关。(C)2017年，由胸外科医生学会主办
Background. Delayed chest closure is an increasingly used approach in the management of bleeding and hemodynamic instability after lung transplantation. We sought to evaluate the impact of delayed chest closure on surgical site infection.Methods. We performed a single-center retrospective cohort study and included adult patients who received a lung transplant at our center between January 1, 2010, and July 31, 2014. We defined surgical site infection as a thoracotomy incision wound or pleural space infection. Follow-up was complete through 6 months after transplantation. We used logistic regression models to examine the impact of delayed chest closure on surgical site infection and to identify other potential risk factors.Results. During the study period, 67 of the 232 transplant procedures (29%) required delayed chest closure, and surgical site infection developed in 22 recipients (9%). Among the patients with surgical site infection, 18 experienced a wound infection, and 8 experienced a pleural space infection; 4 experienced concomitant wound and pleural space infection. Among the 67 who underwent delayed chest closure, 13 patients (19%) experienced a surgical site infection compared with 9 of the 165 patients (5%) who underwent primary closure (p = 0.001). In multivariate analysis, delayed chest closure was an independent risk factor for surgical site infection.Conclusions. Although delayed chest closure may have an important role in the immediate management of recipients of a lung transplant, it is an independent risk factor for surgical site infection, and this is associated with increased morbidity. (C) 2017 by The Society of Thoracic Surgeons