Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH; Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, OH.
J Am Coll Surg. 2013 Oct;217(4):628-35. doi: 10.1016/j.jamcollsurg.2013.05.024. Epub 2013 Jul 10.
Postoperative infections increase morbidity, resource use, and costs. Our objective was to examine whether within guideline recommendations an optimal time exists for an initial dose of antibiotic to reduce postoperative infections in general surgery, and to simulate the magnitude of a reduction in infections should an optimal time be implemented.
The population consisted of 6,731 patients who underwent 7,095 general surgery procedures between January 5, 2006 and June 25, 2012. Patients with pre-existing infections, such as pneumonia and sepsis, and patients with no recorded use of antibiotics were excluded, as were patients on vancomycin and surgical procedures longer than 4 hours in duration. The final analysis dataset included 4,453 patients. The National Surgical Quality Improvement Program was used for perioperative variables and outcomes. The end point was a composite of wound disruption; superficial, deep, organ space, surgical site infections; and sepsis. Semi-parametric logistic regression was used to study the association between antibiotic timing and infection.
There were 444 (10%) patients with a primary end point of infectious complication. A nonlinear "bowl-shaped" relationship between duration of interval from antibiotic administration and surgical incision and infection was observed; lowest risk corresponding to administration time close to incision was 4 minutes before incision (95% one-sided CI, 0-18 minutes). The model suggested optimal timing would result in an 11.3% reduction in the primary infection end point.
Risk of infectious complications decreased as antibiotic administration moved closer to incision time. These data suggest an opportunity to reduce infections by 11.3% by targeting initial antibiotic administration closer to incision.
术后感染会增加发病率、资源使用和成本。我们的目的是研究在指南建议范围内，是否存在一个使初始剂量抗生素发挥作用的最佳时间，以降低普通外科手术后的感染率，并模拟如果实施最佳时间，感染率将降低多少。
该人群包括 6731 名于 2006 年 1 月 5 日至 2012 年 6 月 25 日期间接受 7095 例普通外科手术的患者。排除术前已有感染（如肺炎和败血症）和未记录抗生素使用的患者，以及万古霉素和手术时间超过 4 小时的患者。最终分析数据集包括 4453 名患者。国家外科质量改进计划用于围手术期变量和结果。终点是伤口破裂；浅表、深部、器官间隙、手术部位感染；和败血症的复合。半参数逻辑回归用于研究抗生素时间与感染之间的关联。
有 444 名（10%）患者发生了感染并发症的主要终点。在抗生素给药时间与手术切口和感染之间观察到了一种非线性的“碗状”关系；接近切口时风险最低，为切口前 4 分钟（95%单侧 CI，0-18 分钟）。该模型表明，最佳时机将使主要感染终点降低 11.3%。
随着抗生素给药时间接近切口时间，感染并发症的风险降低。这些数据表明，通过将初始抗生素给药更接近切口，可以将感染率降低 11.3%。
