Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J
De Montfort University, Leicester, UK.
J Hosp Infect. 2009 Jul;72(3):243-50. doi: 10.1016/j.jhin.2009.03.021. Epub 2009 May 15.
A growing number of surveillance studies have highlighted concerns with relying only on data from inpatients. Without post-discharge surveillance (PDS) data, the rate and burden of surgical site infections (SSIs) are underestimated. PDS data for colorectal surgery in the UK remains to be published. This is an important specialty to study since it is considered to have the highest SSI rate and is among the most expensive to treat. This study of colorectal SSI used a 30 day surveillance programme with telephone interviews and home visits. Each additional healthcare resource used by patients with SSI was documented and costed. Of the 105 patients who met the inclusion criteria and completed the 30 day follow-up, 29 (27%) developed SSI, of which 12 were diagnosed after discharge. The mean number of days to presentation of SSI was 13. Multivariable logistic analysis identified body mass index as the only significant risk factor. The additional cost of treating each infected patient was pound sterling 10,523, although 15% of these additional costs were met by primary care. The 5 month surveillance programme cost pound sterling 5,200 to run. An analysis of the surveillance nurse's workload showed that the nurse could be replaced by a healthcare assistant. PDS to detect SSI after colorectal surgery is necessary to provide complete data with accurate additional costs.
越来越多的监测研究强调了仅依赖住院患者数据的问题。如果没有出院后监测（PDS）数据，手术部位感染（SSI）的发生率和负担就会被低估。英国结直肠手术的PDS数据仍有待公布。这是一个重要的研究领域，因为它被认为具有最高的SSI发生率，且治疗费用也是最高的之一。这项关于结直肠SSI的研究采用了一个为期30天的监测计划，通过电话访谈和家访进行。记录并计算了SSI患者使用的每一项额外医疗资源及其成本。在符合纳入标准并完成30天随访的105名患者中，29名（27%）发生了SSI，其中12名在出院后被诊断。出现SSI的平均天数为13天。多变量逻辑分析确定体重指数是唯一的显著风险因素。治疗每名感染患者的额外费用为10523英镑，不过这些额外费用的15%由初级保健支付。为期5个月的监测计划运行成本为5200英镑。对监测护士工作量的分析表明，可以由一名医疗助理替代该护士。结直肠手术后进行PDS以检测SSI对于提供完整数据和准确的额外成本是必要的。
