Hollenbeak C S, Alfrey E J, Souba W W
Department of Surgery, Pennsylvania State College of Medicine, Hershey, 17033, USA.
Surgery. 2001 Aug;130(2):388-95. doi: 10.1067/msy.2001.116666.
Although postoperative infections have a significant impact on morbidity and mortality after orthotopic liver transplantation (OLT), less is known about their economic implications. In this study, we sought to identify risk factors and estimate the impact of surgical site infections on 1-year mortality, graft survival, and resource utilization after OLT.
We studied 777 first, single-organ liver transplant recipients from the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database. Surgical site infections (n = 292, 37.8%) were defined as bacterial or fungal infections of the liver, intestine, biliary tract, surgical wound, or peritoneum within 1 year of transplantation. A subset of these (n = 159) occurred during the transplant hospitalization and were used to estimate excess charges associated with surgical site infections.
Leaks in the choledochojejunostomy (odds ratio [OR] = 7.1, P =.001) and choledochocholedochostomy (OR = 2.5, P =.002), extended operation duration in hours (OR = 1.2, P =.002), serum albumin levels in grams per liters (OR = 0.71, P =.009), ascites (OR = 1.43, P =.037), and administration of OKT3 within 7 days (OR = 1.49, P =.039) significantly increased risk of infection. Surgical site infections did not significantly increase 1-year mortality (88.5% vs 91.5%, P =.19) but significantly increased 1-year graft loss (79.8% vs 86.5%, P =.022). Patients with surgical site infections incurred approximately 24 extra hospital days and $159,967 in excess charges (P =.0001). Multivariate analysis reduced the estimate of excess charges to $131,276 (P =.0001).
Liver transplant recipients who develop surgical site infection have significantly higher resource utilization requirements than those who do not. These results imply substantial returns to preventative efforts directed at surgical site infections in patients undergoing OLT.
尽管术后感染对原位肝移植（OLT）后的发病率和死亡率有重大影响，但对其经济影响的了解较少。在本研究中，我们试图确定危险因素，并评估手术部位感染对OLT后1年死亡率、移植物存活率和资源利用的影响。
我们研究了来自美国国立糖尿病、消化和肾脏疾病研究所肝移植数据库的777例首次单器官肝移植受者。手术部位感染（n = 292，37.8%）定义为移植后1年内肝脏、肠道、胆道、手术伤口或腹膜的细菌或真菌感染。其中一部分（n = 159）发生在移植住院期间，用于估计与手术部位感染相关的额外费用。
胆总管空肠吻合口漏（比值比[OR] = 7.1，P =.001）和胆总管胆总管吻合口漏（OR = 2.5，P =.002）、手术持续时间延长（以小时计，OR = 1.2，P =.002）、血清白蛋白水平（以克/升计，OR = 0.71，P =.009）、腹水（OR = 1.43，P =.037）以及7天内使用OKT3（OR = 1.49，P =.039）显著增加感染风险。手术部位感染未显著增加1年死亡率（88.5%对91.5%，P =.19），但显著增加1年移植物丢失率（79.8%对86.5%，P =.022）。发生手术部位感染的患者额外住院约24天，额外费用约为159,967美元（P =.0001）。多因素分析将额外费用估计降至131,276美元（P =.0001）。
发生手术部位感染的肝移植受者比未发生感染的受者资源利用需求显著更高。这些结果表明，针对接受OLT患者的手术部位感染采取预防措施会有可观的回报。
