Wick Elizabeth C, Vogel Jon D, Church James M, Remzi Feza, Fazio Victor W
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Dis Colon Rectum. 2009 Mar;52(3):374-9. doi: 10.1007/DCR.0b013e31819a5e45.
In 2006, the Cleveland Clinic was a "high outlier" for surgical site infections in the National Surgical Quality Improvement Program. Because this finding may be due to a high proportion of colorectal procedures at the Cleveland Clinic, the purpose of the present study was to compare the national and Cleveland Clinic databases regarding proportion of colorectal procedures and to investigate the frequency of SSI after colorectal versus general and vascular surgery and the factors that predict risk of SSI.
Logistic regression analysis was used to analyze patient and procedure factors in cases with and those without surgical site infections from the Cleveland Clinic's National Surgical Quality Improvement Program database.
Compared with the national database, the Clinic database had a significantly higher proportion of patients who had undergone colorectal procedures: 9.4 percent (11,102/118,391) vs. 17.0 percent (280/1,646) (P < 0.05). The overall surgical site infection (SSI) rate was 5.6 percent for the national database and 9.4 percent for the Clinic. However, in both databases, SSI rates were considerably higher for colorectal procedures than for general and vascular surgery: Clinic, 14.3 percent for colorectal and 9.4 percent for general and vascular procedures (P < 0.05); national database, 15.7 percent for colorectal and 5.6 percent for general and vascular (P < 0.05). Patient-related risks for surgical site infection in colorectal cases were body mass index >30, platelet count <150/microl, age > 55. Procedure-related risk was operation duration >180 min (all P < 0.05).
Participation in the National Surgical Quality Improvement Program brought attention to our high rate of SSI, which appeared to be due to a high proportion of colorectal patients, a high-risk subset. Further analysis identified unique SSI risk factors in this subgroup; most are not amenable to modification. Colorectal surgery may require unique risk adjustment for SSIs because of the nature of the operations and inherent risk of SSIs.
2006年，在国家外科质量改进计划中，克利夫兰诊所的手术部位感染率处于“高度异常”状态。由于这一发现可能是因为克利夫兰诊所的结直肠手术比例较高，本研究的目的是比较国家数据库和克利夫兰诊所数据库中结直肠手术的比例，并调查结直肠手术与普通外科和血管外科手术后手术部位感染的频率以及预测手术部位感染风险的因素。
采用逻辑回归分析方法，对克利夫兰诊所国家外科质量改进计划数据库中发生手术部位感染和未发生手术部位感染的病例的患者和手术因素进行分析。
与国家数据库相比，诊所数据库中接受结直肠手术的患者比例显著更高：9.4%（11,102/118,391）对17.0%（280/1,646）（P < 0.05）。国家数据库的总体手术部位感染（SSI）率为5.6%，诊所为9.4%。然而，在两个数据库中，结直肠手术的SSI率均显著高于普通外科和血管外科手术：诊所，结直肠手术为14.3%，普通外科和血管手术为9.4%（P < 0.05）；国家数据库，结直肠手术为15.7%，普通外科和血管手术为5.6%（P < 0.05）。结直肠病例中与患者相关的手术部位感染风险因素为体重指数>30、血小板计数<150/微升、年龄>55岁。与手术相关的风险因素为手术持续时间>180分钟（所有P < 0.05）。
参与国家外科质量改进计划使我们注意到我们较高的手术部位感染率，这似乎是由于结直肠患者比例较高，这是一个高风险亚组。进一步分析确定了该亚组中独特的手术部位感染风险因素；大多数因素无法改变。由于手术性质和手术部位感染的固有风险，结直肠手术可能需要针对手术部位感染进行独特的风险调整。
