利用 ACS-NSQIP 评估伤口分类系统的手术部位感染。

An evaluation of surgical site infections by wound classification system using the ACS-NSQIP.

机构信息

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0005, USA.

出版信息

J Surg Res. 2012 May 1;174(1):33-8. doi: 10.1016/j.jss.2011.05.056. Epub 2011 Jun 24.

DOI:10.1016/j.jss.2011.05.056

PMID:21962737

Abstract

BACKGROUND

Surgical wound classification has been the foundation for infectious risk assessment, perioperative protocol development, and surgical decision-making. The wound classification system categorizes all surgeries into: clean, clean/contaminated, contaminated, and dirty, with estimated postoperative rates of surgical site infection (SSI) being 1%-5%, 3%-11%, 10%-17%, and over 27%, respectively. The present study evaluates the associated rates of the SSI by wound classification using a large risk adjusted surgical patient database.

METHODS

A cross-sectional study was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset between 2005 and 2008. All surgical cases that specified a wound class were included in our analysis. Patient demographics, hospital length of stay, preoperative risk factors, co-morbidities, and complication rates were compared across the different wound class categories. Surgical site infection rates for superficial, deep incisional, and organ/space infections were analyzed among the four wound classifications using multivariate logistic regression.

RESULTS

A total of 634,426 cases were analyzed. From this sample, 49.7% were classified as clean, 35.0% clean/contaminated, 8.56% contaminated, and 6.7% dirty. When stratifying by wound classification, the clean, clean/contaminated, contaminated, and dirty wound classifications had superficial SSI rates of 1.76%, 3.94%, 4.75%, and 5.16%, respectively. The rates of deep incisional infections were 0.54%, 0.86%, 1.31%, and 2.1%. The rates for organ/space infection were 0.28%, 1.87%, 2.55%, and 4.54%.

CONCLUSION

Using ACS-NSQIP data, the present study demonstrates substantially lower rates of surgical site infections in the contaminated and dirty wound classifications than previously reported in the literature.

摘要

背景

手术伤口分类一直是感染风险评估、围手术期方案制定和手术决策的基础。伤口分类系统将所有手术分为：清洁、清洁/污染、污染和肮脏，估计术后手术部位感染（SSI）的发生率分别为 1%-5%、3%-11%、10%-17%和超过 27%。本研究使用大型风险调整手术患者数据库评估了伤口分类相关的 SSI 发生率。

方法

使用美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据集进行横断面研究，时间为 2005 年至 2008 年。我们的分析包括所有指定伤口类别的手术病例。比较不同伤口类别患者的人口统计学特征、住院时间、术前危险因素、合并症和并发症发生率。使用多元逻辑回归分析 4 种伤口分类的浅表、深部切口和器官/空间感染的 SSI 发生率。

结果

共分析了 634426 例病例。在该样本中，49.7%被归类为清洁，35.0%为清洁/污染，8.56%为污染，6.7%为肮脏。按伤口分类分层时，清洁、清洁/污染、污染和肮脏伤口分类的浅表 SSI 发生率分别为 1.76%、3.94%、4.75%和 5.16%。深部切口感染的发生率分别为 0.54%、0.86%、1.31%和 2.1%。器官/空间感染的发生率分别为 0.28%、1.87%、2.55%和 4.54%。