Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Dis Colon Rectum. 2010 Feb;53(2):143-9. doi: 10.1007/DCR.0b013e3181bb0d1d.
Surgery for inflammatory bowel disease is known to be have an increased risk of morbidity. Few studies have investigated the risk factors for surgical site infection in patients undergoing surgery for inflammatory bowel disease restricted to ulcerative colitis, and no known precise evaluation of risk factors has been presented because of the many differences and confounding factors, such as disease specificities, surgical procedures, and patient characteristics. We evaluated the influences of patient conditions on the occurrence of surgical site infection after an ileal J-pouch-anal anastomosis for ulcerative colitis.
Surgical site infections in 192 patients with ulcerative colitis who underwent surgery at Hyogo College of Medicine between March 2006 and April 2008 were investigated. Possible risk factors for surgical site infection were analyzed by univariate and multivariate logistic regression analyses to determine the predictive significance of those factors.
The incidence of incisional surgical site infection was 12.5%, and the incidence of organ/space surgical site infection was 1.6%. In a stepwise logistic regression model, total prednisolone >or=10,000 mg (odds ratio, 3.33; 95% CI 1.03-10.73;P = .04) and American Society of Anesthesiologists' score >or=3 (odds ratio, 3.45; 95% CI 1.12-10.62; P = .03) were shown to be independent risk factors for incisional surgical site infection, whereas no risk factors were found for overall surgical site infection.
Our results indicate that a higher total steroid dose is related to incisional surgical site infection with fewer confounding factors in patients with ulcerative colitis. In addition, total prednisolone >or=10,000 mg may be an additional factor for surgical indication in these patients.
已知炎性肠病的手术风险增加，发病率高。少数研究调查了溃疡性结肠炎患者接受手术治疗炎性肠病的手术部位感染的危险因素，由于疾病特异性、手术程序和患者特征等诸多差异和混杂因素，尚未对危险因素进行精确评估。我们评估了患者状况对溃疡性结肠炎行回肠 J 袋 - 直肠吻合术术后发生手术部位感染的影响。
调查了 2006 年 3 月至 2008 年 4 月在兵库医科大学接受手术的 192 例溃疡性结肠炎患者的手术部位感染情况。通过单变量和多变量逻辑回归分析分析可能的手术部位感染危险因素，以确定这些因素的预测意义。
切口手术部位感染的发生率为 12.5%，器官/空间手术部位感染的发生率为 1.6%。在逐步逻辑回归模型中，总泼尼松龙≥10000mg（比值比，3.33；95%可信区间 1.03-10.73；P=0.04）和美国麻醉师协会评分≥3（比值比，3.45；95%可信区间 1.12-10.62；P=0.03）被证明是切口手术部位感染的独立危险因素，而总体手术部位感染无危险因素。
我们的结果表明，在溃疡性结肠炎患者中，较高的总类固醇剂量与切口手术部位感染相关，混杂因素较少。此外，泼尼松龙总量≥10000mg 可能是这些患者手术适应证的附加因素。
