Department of Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, USA.
Surgery. 2013 Jan;153(1):86-94. doi: 10.1016/j.surg.2012.03.026. Epub 2012 Jun 13.
Infection control is potentially a critical quality indicator but remains incompletely understood, especially in high-acuity gastrointestinal surgery. Our objective was to evaluate the incidence and impact of infections after elective pancreatectomy at the practice level.
All pancreatectomies performed by three pancreatic surgical specialists over an 8-year period (2001-2009) followed standardized perioperative care, including timely antibiotic administration. Infections were defined according to National Surgery Quality Improvement Program criteria, while complication severity was based on Clavien grade. Clinical and economic outcomes were evaluated and predictors of infection identified by regression analysis.
Of 550 major pancreatic resections, 288 (53%) had some complication, of which 167 (31%) were infectious. Rates of infection differed by type of resection (proximal pancreatectomy > others; P = .029) but not by presence of malignancy. Major infections (Clavien 3-5; n = 62), occurred in 11% of cases. Infection was not the primary cause of death in any patient. Infection was associated with increases in hospital stay, operative times, transfusions, blood loss, intensive care unit use, and readmission (34% vs 12%). Types of infection were as follows: wound infection (14%), infected pancreatic fistula (9%), urinary tract infection (7%), pneumonia (6%), and sepsis (2%). The use of total parenteral nutrition (odds ratio [OR], 7.3), coronary artery disease (OR, 2.1), and perioperative hypotension (OR, 1.6) predicted any infection. Total costs for cases with infection increased grade-for-grade across the Clavien scale, with infection accounting for 38% of the overall cost differential.
Infectious complications occurred frequently, compromising numerous outcomes and increasing costs markedly. These data provide a foundation for understanding the baseline consequences of infection in high-acuity gastrointestinal surgery and offer opportunities for process evaluation and initiatives in infection control at the practice level.
感染控制是一个潜在的关键质量指标，但在高难度胃肠外科手术中仍未得到充分理解。我们的目的是评估在实践层面上择期胰切除术的感染发生率和影响。
在 8 年期间（2001-2009 年），三位胰腺外科专家进行的所有胰切除术均遵循标准化围手术期护理，包括及时使用抗生素。感染根据国家手术质量改进计划的标准进行定义，而并发症的严重程度则基于 Clavien 分级。评估临床和经济结果，并通过回归分析确定感染的预测因素。
550 例主要胰腺切除术中，288 例（53%）出现了某种并发症，其中 167 例（31%）为感染性并发症。切除类型不同，感染率也不同（胰体尾切除术>其他类型；P=0.029），但肿瘤的存在与否并不影响感染率。主要感染（Clavien 3-5 级；n=62）的发生率为 11%。在任何患者中，感染均不是死亡的主要原因。感染与住院时间延长、手术时间延长、输血、失血、重症监护病房使用和再入院（34%比 12%）增加有关。感染的类型如下：伤口感染（14%）、感染性胰瘘（9%）、尿路感染（7%）、肺炎（6%）和败血症（2%）。全肠外营养（比值比[OR]，7.3）、冠状动脉疾病（OR，2.1）和围手术期低血压（OR，1.6）的使用预测了任何感染。Clavien 分级越高，感染病例的总费用也越高，感染占总费用差异的 38%。
感染性并发症频繁发生，严重影响了许多结果并显著增加了成本。这些数据为了解高难度胃肠外科手术中感染的基本后果提供了基础，并为实践层面上的感染控制过程评估和举措提供了机会。
