一般手术持续时间与增加的风险调整后感染并发症发生率和住院时间延长有关。
General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay.
机构信息
Department of Surgery, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
出版信息
J Am Coll Surg. 2010 Jan;210(1):60-5.e1-2. doi: 10.1016/j.jamcollsurg.2009.09.034. Epub 2009 Nov 18.
BACKGROUND
Studies of specific procedures have shown increases in infectious complications with operative duration. We hypothesized that operative duration is independently associated with increased risk-adjusted infectious complication (IC) rates in a broad range of general surgical procedures.
STUDY DESIGN
We queried the American College of Surgeons National Surgical Quality Improvement Program database for general surgical operations performed from 2005 to 2007. ICs (wound infection, sepsis, urinary tract infection, and/or pneumonia) and length of hospital stay (LOS) were evaluated versus operative duration (OD, ie, incision to closure). Multivariable regression adjusted for 38 patient risk variables, operation type and complexity, wound class and intraoperative transfusion. We also analyzed isolated laparoscopic cholecystectomies in patients of American Society of Anesthesiologists class 1 or 2, without intraoperative transfusion and with a clean or clean-contaminated wound class.
RESULTS
In 299,359 operations performed at 173 hospitals, unadjusted IC rates increased linearly with OD at a rate of close to 2.5% per half hour (chi-square test for linear trend, p < 0.001). After adjustment, IC risk increased for each half hour of OD relative to cases lasting <or=1 hour, almost doubling at 2.1 to 2.5 hours (odds ratio = 1.92; 95% CI, 1.82 to 2.03; p < 0.001). In isolated laparoscopic cholecystectomy, IC rates increased linearly with OD (n = 17,018, chi-square test for linear trend, p < 0.001) with rates for 1.1 to 1.5 hour cases (1.4%) doubling those lasting <or=0.5 hour (0.7%). Across all procedures, adjusted LOS increased geometrically with operative duration at a rate of about 6% per half hour (coefficient for natural log transformed LOS = 0.059 per half hour; 95% CI, 0.058 to 0.060; p < 0.001).
CONCLUSIONS
Operative duration is independently associated with increased ICs and LOS after adjustment for procedure and patient risk factors.
背景
针对特定手术程序的研究表明，手术时间的延长与感染并发症的增加有关。我们假设，在广泛的普通外科手术中，手术时间与风险调整后感染性并发症（IC）发生率的增加独立相关。
研究设计
我们在美国外科医师学院国家手术质量改进计划数据库中查询了 2005 年至 2007 年期间进行的普通外科手术。评估了 IC（伤口感染、败血症、尿路感染和/或肺炎）和住院时间（ LOS）与手术时间（OD，即切口到闭合）的关系。多变量回归调整了 38 个患者风险变量、手术类型和复杂性、伤口类别和术中输血。我们还分析了美国麻醉师学会（ASA）分级 1 或 2 级、无术中输血且伤口分类为清洁或清洁污染的患者的单纯腹腔镜胆囊切除术。
结果
在 173 家医院进行的 299359 例手术中，未调整的 IC 率随 OD 线性增加，每半小时增加近 2.5%（线性趋势的卡方检验，p<0.001）。调整后，与持续时间<或=1 小时的病例相比，每半小时 OD 增加 IC 风险，在 2.1 至 2.5 小时时几乎翻倍（比值比=1.92；95%CI，1.82 至 2.03；p<0.001）。在单纯腹腔镜胆囊切除术，IC 率随 OD 线性增加（n=17018，线性趋势的卡方检验，p<0.001），1.1 至 1.5 小时病例的 IC 率是持续时间<或=0.5 小时病例的两倍（0.7%）。在所有手术中，调整后的 LOS 以大约每半小时 6%的速度呈几何级数增加（自然对数转换的 LOS 系数为每半小时 0.059；95%CI，0.058 至 0.060；p<0.001）。
结论
在调整手术和患者风险因素后，手术时间与 IC 和 LOS 的增加独立相关。
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