Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei 110, Taiwan.
Br J Anaesth. 2011 Nov;107(5):757-61. doi: 10.1093/bja/aer262. Epub 2011 Aug 19.
This study compared the odds ratio (OR) of surgical site infection (SSI) within 30 days after operation with general anaesthesia (GA) or neuraxial anaesthesia (NA) in Taiwanese women undergoing Caesarean delivery (CD).
An epidemiologic design was used. The study population was based on the records of all deliveries in hospitals or obstetric clinics between January 2002 and December 2006 in Taiwan. Anonymized claim data from the Taiwan National Health Insurance Research Database (NHIRD) were analysed. Women who received CD were identified from the NHIRD by Diagnosis-Related Group codes. The mode of anaesthesia was defined by order codes. Multivariate logistic regression was used to estimate the OR and associated 95% confidence interval (CI) of post-CD SSIs for GA when compared with NA. The outcome was whether a woman had been diagnosed as having an SSI during the hospitalization or was re-hospitalized within 30 days after CD for the treatment of SSIs using five or 81 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.
Among the 303 834 Taiwanese women who underwent CD during the 5 yr observation period, the 30 day post-CD SSI rate was 0.3% or 0.9% based on five or 81 ICD-9-CM codes. The multivariate-adjusted OR of having post-CD SSIs in the GA group was 3.73 (95% CI, 3.07-4.53) compared with the NA group (P<0.001) using five ICD-9-CM codes for the definition of SSI.
GA for CD was associated with a higher risk of SSI when compared with neuraxial anaesthesia.
本研究比较了在台湾行剖宫产术的女性中，全身麻醉（GA）与椎管内麻醉（NA）术后 30 天内手术部位感染（SSI）的优势比（OR）。
采用流行病学设计。研究人群基于 2002 年 1 月至 2006 年 12 月台湾所有医院或妇产科诊所分娩的记录。从台湾全民健康保险研究数据库（NHIRD）的匿名理赔数据中分析。NHIRD 通过疾病相关组代码识别接受剖宫产术的女性。麻醉方式通过医嘱代码定义。采用多变量逻辑回归估计 GA 与 NA 相比，CD 后 SSI 的 OR 及其 95%置信区间（CI）。结局是通过 5 个或 81 个国际疾病分类，第九修订版，临床修正（ICD-9-CM）代码，在住院期间诊断为 SSI 的女性，或在 CD 后 30 天内因 SSI 再次住院治疗的女性的比例。
在 5 年观察期内，303834 名接受剖宫产术的台湾女性中，基于 5 个或 81 个 ICD-9-CM 代码，30 天内 CD 后 SSI 发生率为 0.3%或 0.9%。使用 5 个 ICD-9-CM 代码定义 SSI，GA 组 CD 后发生 SSI 的多变量调整 OR 为 3.73（95%CI，3.07-4.53），与 NA 组相比（P<0.001）。
与椎管内麻醉相比，全身麻醉与剖宫产术后 SSI 的风险增加相关。
