Hollenbeak C S, Alfrey E J, Sheridan K, Burger T L, Dillon P W
Departments of Surgery and Health Evaluation Sciences, Penn State College of Medicine, PO Box 850, 500 University Drive, MC H113, Hershey, PA 17033, USA.
Transpl Infect Dis. 2003 Jun;5(2):72-8. doi: 10.1034/j.1399-3062.2003.00013.x.
Infectious complications following orthotopic liver transplantation (OLT) represent a significant cause of morbidity and mortality in both adults and children. In adults, surgical site infections complicating OLT have been shown to significantly increase resource utilization, but their impact in children has not been studied. In this study we identify risk factors for surgical site infections in children undergoing primary OLT for end-stage liver disease and estimate their impact on patient survival, graft survival, length of stay, and charges.
All pediatric liver transplants (n = 77) less than 16 years of age from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Liver Transplantation Database were included in the analysis. Surgical site infections (n = 25) were defined as wound infections, abdominal abscesses, and bacterial or fungal infections of the liver, intestine, or peritoneum during the initial transplant admission. Risk of infection was estimated using logistic regression, survival rates were estimated using the Kaplan-Meier method, and length of stay and charges were compared using Student's t-test. Multivariate analysis of charges was performed using linear regression.
Of the 77 patients, 25 (32.5%) developed a surgical site infection. Several factors were associated with increased risk of infections, including a leak at the biliary anastomosis (odds ratio [OR] 115, P = 0.003), preoperative white blood cell count (OR = 1.28, P = 0.009), surgery > 7 h (OR = 15.0, P = 0.011), HLA mismatches (OR = 6.0, P = 0.03), and female gender (OR = 8.0, P = 0.038). Surgical site infections did not significantly decrease either patient survival or graft survival, and increased hospital stay by an average of 21 days (P = 0.14). After controlling for other factors, patients who developed surgical site infections incurred on average $132,507 (P = 0.03) more in charges than patients who did not develop infections.
Surgical site infections in pediatric patients following liver transplantation are significantly influenced by surgical technique and endogenous patient characteristics. Though survival outcomes are not different, the development of such infections has significant implications for resource utilization in the care of these patients.
原位肝移植（OLT）后的感染并发症是成人和儿童发病和死亡的重要原因。在成人中，OLT术后并发的手术部位感染已被证明会显著增加资源利用，但它们对儿童的影响尚未得到研究。在本研究中，我们确定了终末期肝病接受初次OLT的儿童手术部位感染的危险因素，并评估了其对患者生存、移植物存活、住院时间和费用的影响。
分析美国国立糖尿病、消化和肾脏疾病研究所（NIDDK）肝移植数据库中所有年龄小于16岁的小儿肝移植患者（n = 77）。手术部位感染（n = 25）定义为初次移植住院期间的伤口感染、腹腔脓肿以及肝脏、肠道或腹膜的细菌或真菌感染。使用逻辑回归估计感染风险，使用Kaplan-Meier方法估计生存率，并使用学生t检验比较住院时间和费用。使用线性回归对费用进行多变量分析。
77例患者中，25例（32.5%）发生了手术部位感染。几个因素与感染风险增加相关，包括胆肠吻合口漏（比值比[OR] 115，P = 0.003）、术前白细胞计数（OR = 1.28，P = 0.009）、手术时间> 7小时（OR = 15.0，P = 0.011）、HLA错配（OR = 6.0，P = 0.03）和女性性别（OR = 8.0，P = 0.038）。手术部位感染并未显著降低患者生存率或移植物存活率，平均住院时间增加了21天（P = 0.14）。在控制其他因素后，发生手术部位感染的患者比未发生感染的患者平均多花费132,507美元（P = 0.03）。
小儿肝移植术后的手术部位感染受手术技术和患者自身因素的显著影响。虽然生存结果没有差异，但此类感染的发生对这些患者的护理资源利用有重大影响。
