Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0005, USA.
J Surg Res. 2012 May 1;174(1):33-8. doi: 10.1016/j.jss.2011.05.056. Epub 2011 Jun 24.
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.
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.
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%.
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.
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。
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。
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%。
使用 ACS-NSQIP 数据，本研究表明污染和肮脏伤口分类的手术部位感染率明显低于文献报道。
