Hübner Martin, Diana Michele, Zanetti Giorgio, Eisenring Marie-Christine, Demartines Nicolas, Troillet Nicolas
Department of Visceral Surgery University Hospital, Lausanne, Switzerland.
Arch Surg. 2011 Nov;146(11):1240-5. doi: 10.1001/archsurg.2011.176. Epub 2011 Jul 18.
To determine the role of the surgeon in the occurrence of surgical site infection (SSI) following colon surgery, with respect to his or her adherence to guidelines and his or her experience.
DESIGN, SETTING, AND PATIENTS: Prospective cohort study of 2393 patients who underwent colon surgery performed by 31 surgeons in 9 secondary and tertiary care public Swiss hospitals, recruited from a surveillance program for SSI between March 1, 1998, and December 31, 2008, and followed up for 1 month after their operation.
Risk factors for SSI were identified in univariate and multivariate analyses that included the patients' and procedures' characteristics, the hospitals, and the surgeons as candidate covariates. Correlations were sought between surgeons' individual adjusted risks, their self-reported adherence to guidelines, and the delay since their board certification.
A total of 428 SSIs (17.9%) were identified, with hospital rates varying from 4.0% to 25.2% and individual surgeon rates varying from 3.7% to 36.1%. Features of the patients and procedures associated with SSI in univariate analyses were male sex, age, American Society of Anesthesiologists score, contamination class, operation duration, and emergency procedure. Correctly timed antibiotic prophylaxis and laparoscopic approach were protective. Multivariate analyses adjusting for these features and for the hospitals found 4 surgeons with higher risk of SSI (odds ratio [OR] = 2.37, 95% confidence interval [CI], 1.51-3.70; OR = 2.19, 95% CI, 1.41-3.39; OR = 2.15, 95% CI, 1.02-4.53; and OR = 1.97, 95% CI, 1.18-3.30) and 2 surgeons with lower risk of SSI (OR = 0.43, 95% CI, 0.19-0.94; and OR = 0.19, 95% CI, 0.04-0.81). No correlation was found between surgeons' individual adjusted risks and their adherence to guidelines or their experience.
For reasons beyond adherence to guidelines or experience, the surgeon may constitute an independent risk factor for SSI after colon surgery.
确定外科医生在结肠手术后手术部位感染（SSI）发生过程中的作用，涉及他们对指南的遵循情况及其经验。
设计、设置和患者：对1998年3月1日至2008年12月31日期间在瑞士9家二级和三级公立医疗机构中由31名外科医生进行结肠手术的2393例患者进行前瞻性队列研究，并在术后随访1个月。
在单因素和多因素分析中确定SSI的危险因素，这些分析包括患者和手术的特征、医院以及作为候选协变量的外科医生。研究外科医生个体调整后的风险、他们自我报告的对指南的遵循情况以及自获得委员会认证以来的时间间隔之间的相关性。
共识别出428例SSI（17.9%），医院感染率在4.0%至25.2%之间，个体外科医生感染率在3.7%至36.1%之间。单因素分析中与SSI相关的患者和手术特征包括男性、年龄、美国麻醉医师协会评分、污染等级、手术持续时间和急诊手术。正确时机的抗生素预防和腹腔镜手术方式具有保护作用。在对这些特征和医院进行调整的多因素分析中，发现4名外科医生发生SSI的风险较高（比值比[OR]=2.37，95%置信区间[CI]，1.51 - 3.70；OR = 2.19，95% CI，1.41 - 3.39；OR = 2.15，95% CI，1.02 - 4.53；OR = 1.97，95% CI，1.18 - 3.30），2名外科医生发生SSI的风险较低（OR = 0.43，95% CI，0.19 - 0.94；OR = 0.19，95% CI，0.04 - 0.81）。未发现外科医生个体调整后的风险与他们对指南的遵循情况或经验之间存在相关性。
由于超出遵循指南或经验之外的原因，外科医生可能是结肠手术后SSI的一个独立危险因素。
