实施捆绑式干预措施可大幅降低心血管手术后深部胸骨伤口感染的发生率。
Implementation of bundled interventions greatly decreases deep sternal wound infection following cardiovascular surgery.
作者信息
Miyahara Ken, Matsuura Akio, Takemura Haruki, Mizutani Shinichi, Saito Shunei, Toyama Masashi
机构信息
Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan.
Division of Cardiovascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Aichi, Japan.
出版信息
J Thorac Cardiovasc Surg. 2014 Nov;148(5):2381-8. doi: 10.1016/j.jtcvs.2014.04.005. Epub 2014 Apr 13.
OBJECTIVE
Surgical site infection (SSI), particularly deep sternal wound infection (DSWI), is a serious complication after cardiovascular surgery because of its high mortality rate. We evaluated the effectiveness of an SSI bundle to reduce DSWI and identify the risk factors for DSWI.
METHODS
During the period January 2004 to February 2012, 1374 consecutive patients undergoing cardiovascular surgery via sternotomy were included. The cohort was separated into periods from January 2004 through February 2007 (period I, 682 patients) and March 2007 through February 2012 (period II, 692 patients). During period II, all preventive measures for DSWI were completed as an SSI bundle. We compared the DSWI rate between the 2 periods. Univariate and multivariate analyses were performed for the entire period to identify the risk factors for DSWI.
RESULTS
DSWI occurred in 13 patients (1.9%) during period I and in 1 patient (0.14%) during period II. The DSWI rate during period II was significantly decreased by 93%, compared with period I (P=.001). Independent risk factors for DSWI included obesity (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.00-11.75; P=.049), the use of 4 sternal wires (OR, 8.2; 95% CI, 1.39-48.14; P=.020), long operative time (OR, 4.4; 95% CI, 1.20-16.23; P=.026), and postoperative renal failure (OR, 9.0; 95% CI, 2.44-33.30; P=.001).
CONCLUSIONS
Complete implementation of simple multidisciplinary prevention measures as a bundle can greatly decrease the incidence of DSWI.
目的
手术部位感染（SSI），尤其是深部胸骨伤口感染（DSWI），因其高死亡率，是心血管手术后的一种严重并发症。我们评估了一套SSI综合措施降低DSWI的有效性，并确定DSWI的危险因素。
方法
在2004年1月至2012年2月期间，纳入1374例连续接受胸骨切开术的心血管手术患者。该队列被分为2004年1月至2007年2月（第一阶段，682例患者）和2007年3月至2012年2月（第二阶段，692例患者）。在第二阶段，所有预防DSWI的措施作为一套SSI综合措施完成。我们比较了两个阶段之间的DSWI发生率。对整个时期进行单因素和多因素分析以确定DSWI的危险因素。
结果
第一阶段有13例患者（1.9%）发生DSWI，第二阶段有1例患者（0.14%）发生DSWI。与第一阶段相比，第二阶段的DSWI发生率显著降低了93%（P = 0.001）。DSWI的独立危险因素包括肥胖（优势比[OR]，3.4；95%置信区间[CI]，1.00 - 11.75；P = 0.049）、使用4根胸骨钢丝（OR，8.2；95% CI，1.39 - 48.14；P = 0.020）、手术时间长（OR，4.4；95% CI，1.20 - 16.23；P = 0.026）和术后肾衰竭（OR，9.0；95% CI，2.44 - 33.30；P = 0.001）。
结论
作为一套综合措施完整实施简单的多学科预防措施可大大降低DSWI的发生率。
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