Bishawi M, Fakhoury M, Denoya P I, Stein S, Bergamaschi R
Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY, USA.
Tech Coloproctol. 2014 Apr;18(4):381-6. doi: 10.1007/s10151-013-1066-z. Epub 2013 Sep 6.
This study was performed to determine impact of open and hand-assisted colorectal resection on surgical site infection (SSI) rates.
National Surgical Quality Improvement Project data from 2006 to 2008 were supplemented with an institutional review board-approved chart review. Primary endpoint was SSI rates defined by the Centers for Disease Control National Nosocomial Infections Surveillance system and classified as superficial, deep incisional, and organ space. Inclusion criteria were elective or emergency open or hand-assisted colorectal resections. Wounds were classified as clean-contaminated, contaminated, or dirty-infected. Patients were not included if they underwent laparoscopic colorectal resection, small bowel resection, or stoma creation.
Two hundred and forty-five consecutive patients were included over a 29-month period. One hundred and ninety-five open and 50 hand-assisted patients were comparable for gender, body mass index, ethnicity, tobacco addiction, steroid use, type of colorectal resection, operating time, and method of wound closure. Differences in ASA class, wound classification, and preexisting comorbidities resolved when 80 open and 5 hand-assisted patients who underwent emergency resections were excluded from analysis. Rate of stoma creation remained higher in open patients even after excluding emergency cases (p < 0.01). Overall SSI rates following open and hand-assisted resections were 28 and 44 %, respectively (p = 0.015). Superficial SSI rates were higher in hand-assisted patients (20 vs. 40 %, p = 0.006). Deep (2.1 vs. 4 %, p = 0.605) and organ space SSI rates (5.1 vs. 0 %, p = 0.221) did not differ. These results did not change when emergency resections were excluded: overall 28 and 44 % (p = 0.015), superficial (23 vs. 44 %, p = 0.009), deep (3.5 vs. 4.4 %, p = 0.541), and organ space (7 vs. 0 %, p = 0.066).
This study seems to suggest possibly higher rates of incisional SSI in patients who underwent hand-assisted colorectal resection as compared to open. This retrospective study had, however, insufficient power to stratify by surgeon and control for risk factors by logistic regression.
本研究旨在确定开放手术和手辅助结直肠切除术对手术部位感染（SSI）率的影响。
补充了经机构审查委员会批准的图表回顾资料，纳入2006年至2008年国家外科质量改进项目的数据。主要终点是由疾病控制中心国家医院感染监测系统定义并分类为浅表、深部切口和器官间隙感染的SSI率。纳入标准为择期或急诊开放或手辅助结直肠切除术。伤口分为清洁-污染、污染或脏污-感染。接受腹腔镜结直肠切除术、小肠切除术或造口术的患者不纳入研究。
在29个月的时间里，连续纳入了245例患者。195例开放手术患者和50例手辅助手术患者在性别、体重指数、种族、吸烟成瘾、类固醇使用、结直肠切除类型、手术时间和伤口缝合方法方面具有可比性。当排除80例接受急诊手术的开放手术患者和5例手辅助手术患者后进行分析时，ASA分级、伤口分类和既往合并症的差异消失。即使排除急诊病例，开放手术患者的造口率仍然较高（p<0.01）。开放手术和手辅助手术后的总体SSI率分别为28%和44%（p=0.015）。手辅助手术患者的浅表SSI率较高（20%对40%，p=0.006）。深部（2.1%对4%，p=0.605）和器官间隙SSI率（5.1%对0%，p=0.221）无差异。排除急诊手术后，这些结果没有改变：总体分别为28%和44%（p=0.015），浅表（23%对44%，p=0.009），深部（3.5%对4.4%，p=0.541）和器官间隙（7%对0%，p=0.066）。
本研究似乎表明，与开放手术相比，接受手辅助结直肠切除术的患者切口SSI率可能更高。然而，这项回顾性研究的样本量不足以按外科医生进行分层，也无法通过逻辑回归控制风险因素。
