Department of General Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Int J Colorectal Dis. 2011 Jan;26(1):61-9. doi: 10.1007/s00384-010-1057-8. Epub 2010 Oct 5.
Surgical site infections (SSIs) are the most common infections in colorectal surgery. Although some studies suggest that rectal surgery differs from colon surgery for SSI incidence and risk factors, the National Nosocomial Infection Surveillance system categorizes all colorectal surgeries into only one group. The aim of this study was to determine incidence, characteristics, and risk factors of SSIs according to the subclassification of colorectal surgery into right colon surgery (RCS), left colon surgery (LCS), and rectum surgery (RS).
From November 2005 to July 2009, all patients requiring colorectal resectioning were enrolled into our program. The outcome of interest was an SSI diagnosis. Univariate and multivariate analyses were performed to determine SSI predictors in each group.
Two hundred seventy-seven consecutive colorectal resections were analyzed. SSI rates were 8% in RCS, 18.4% in LCS, and 17.6% in RS. LCS and RS showed significantly higher SSI incidences (p = 0.022) and greater rates of organ/space infections compared to RCS (p = 0.029). Predictors of SSI were steroid use among RCS, age greater than 70 years, multiple comorbidities, steroid use, non-neoplastic colonic disease, urgent operation, ostomy creation, postoperative intensive care among LCS, preoperative chemoradiation, heart disease, and prolonged operation among RS patients. On multivariate analysis, the coupled LCS and RS groups showed an increased risk for SSI compared to RCS (OR, 2.57).
SSI incidences, characteristics, and risk factors seem to be different among RCS, LCS, and RS. A tailored SSI surveillance program should be applied for each of the three groups, leading to a more competent SSI recognition and reduction of SSI incidence and related costs.
手术部位感染（SSI）是结直肠手术中最常见的感染。虽然一些研究表明直肠手术与结肠手术在 SSI 发生率和危险因素方面有所不同，但全国医院感染监测系统将所有结直肠手术仅归为一组。本研究旨在根据结直肠手术的亚分类，即右半结肠切除术（RCS）、左半结肠切除术（LCS）和直肠切除术（RS），确定 SSI 的发生率、特征和危险因素。
从 2005 年 11 月至 2009 年 7 月，所有需要结直肠切除术的患者均纳入本研究。研究的结局为 SSI 诊断。对每个组进行单因素和多因素分析，以确定 SSI 的预测因素。
分析了 277 例连续的结直肠切除术。RCS 的 SSI 发生率为 8%，LCS 为 18.4%，RS 为 17.6%。LCS 和 RS 的 SSI 发生率明显高于 RCS（p=0.022），且器官/腔隙感染的发生率也高于 RCS（p=0.029）。RCS 中 SSI 的预测因素为使用类固醇、年龄大于 70 岁、多种合并症、使用类固醇、非肿瘤性结肠疾病、急诊手术、造口术、LCS 术后重症监护、术前放化疗、心脏病和手术时间延长；RS 患者的预测因素为术前放化疗、心脏病和手术时间延长。多因素分析显示，LCS 和 RS 联合组与 RCS 相比，SSI 的风险增加（OR=2.57）。
RCS、LCS 和 RS 之间 SSI 的发生率、特征和危险因素似乎不同。应针对这三组分别制定定制的 SSI 监测计划，从而更有效地识别 SSI 并降低 SSI 的发生率和相关成本。
