Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
HPB (Oxford). 2013 May;15(5):384-91. doi: 10.1111/j.1477-2574.2012.00604.x. Epub 2012 Nov 5.
Patients undergoing complex hepatopancreatobiliary (HPB) operations are at high risk for surgical site infection (SSI). Factors such as biliary obstruction, operative time and pancreatic or biliary fistulae contribute to the high SSI rate. The purpose of this study was to analyse whether a multifactorial approach would reduce the incidence and cost of SSI after HPB surgery.
From January 2007 to December 2009, 895 complex HPB operations were monitored for SSI through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). In 2008, surgeon-specific SSI rates were provided to HPB surgeons, and guidelines for the management of perioperative factors were established. Observed SSI rates were monitored before and after these interventions. Hospital cost data were analysed and cost savings were calculated.
Observed SSI for hepatic, pancreatic and complex biliary operations decreased by 9.6% over a 2-year period (P < 0.03). The excess cost per SSI was US$11 462 and was driven by increased length of stay and hospital readmission for infection. Surgeons rated surgeon-specific feedback on SSI rate as the most important factor in improvement.
High SSI rates following complex HPB operations can be improved by a multifactorial approach that features process improvements, individual surgeon feedback and reduced variation in patient management.
接受复杂肝胆胰（HPB）手术的患者存在发生手术部位感染（SSI）的高风险。胆道梗阻、手术时间以及胰瘘或胆瘘等因素导致 SSI 发生率较高。本研究旨在分析多因素方法是否会降低 HPB 手术后 SSI 的发生率和成本。
2007 年 1 月至 2009 年 12 月，通过美国外科医师学院国家外科质量改进计划（ACS-NSQIP）监测 895 例复杂 HPB 手术的 SSI。2008 年，向 HPB 外科医生提供了特定外科医生的 SSI 率，并制定了围手术期因素管理指南。在这些干预措施之前和之后监测观察到的 SSI 率。分析了医院成本数据并计算了节省的成本。
肝、胰和复杂胆道手术的观察性 SSI 在 2 年内下降了 9.6%（P < 0.03）。每个 SSI 的额外成本为 11462 美元，这是由于感染导致住院时间延长和再次住院。外科医生将外科医生特定的 SSI 率反馈评为改善的最重要因素。
通过多因素方法可以改善复杂 HPB 手术后的高 SSI 率，该方法的特点是流程改进、外科医生的个人反馈以及减少患者管理的差异。
