Chu Daniel I, Schlieve Christopher R, Colibaseanu Dorin T, Simpson Paul J, Wagie Amy E, Cima Robert R, Habermann Elizabeth B
Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1720 2nd Avenue South, KB427, Birmingham, AL, 35294, USA,
J Gastrointest Surg. 2015 Feb;19(2):327-34. doi: 10.1007/s11605-014-2649-3. Epub 2014 Sep 13.
Stoma reversals (SRs) are commonly performed with potentially significant postoperative complications including surgical site infections (SSIs). Our aim was to determine the incidence and risk factors for SSIs in a large cohort of SR patients.
We reviewed our institutional 2006-2011 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for 30-day SSIs in patients undergoing SR. Records were additionally reviewed for 10 non-ACS-NSQIP variables. The primary outcome was SSI after SR. Secondary outcomes were additional 30-day postoperative complications and length-of-stay. Predictors of SSIs were identified using multivariable logistic regression.
From 528 SR patients, 36 patients developed a SSI (6.8 %). Most patients underwent SR for loop ileostomies (76.5 %) after index operations for ulcerative colitis (38.6 %) and colorectal cancer (27.8 %). SSI patients had fewer subcutaneous drains compared to patients with no SSI and had significantly higher rates of smoking, ASA 3-4 classification and laparotomies at SR (p < 0.05). Patients with SSI had increased length-of-stay and 30-day morbidities including sepsis and returns to the operating room (p < 0.05) compared to no-SSI patients. On multivariable analysis, subcutaneous drain placement was suggestive of SSI protection (odds ratio [OR] 0.52, 95 % confidence interval [CI] 0.2-1.1), but only smoking was significantly associated with an increased risk for SSI (OR 2.4, 95 % CI 1.1-5.4).
Smoking increased the risk of SR SSIs in patients by over twofold, and SR SSIs are associated with additional significant morbidities. Smoking cessation should be an important part of any SSI risk-reduction strategy.
造口回纳术（SRs）是常见手术，术后可能出现包括手术部位感染（SSIs）在内的严重并发症。我们的目的是确定一大群接受SRs患者中SSIs的发生率及危险因素。
我们回顾了本机构2006年至2011年美国外科医师学会国家外科质量改进计划（ACS - NSQIP）数据库中接受SRs患者的30天SSIs情况。另外还回顾了10个非ACS - NSQIP变量的记录。主要结局是SR术后的SSI。次要结局是术后额外的30天并发症及住院时间。使用多变量逻辑回归确定SSIs的预测因素。
528例接受SRs的患者中，36例发生了SSI（6.8%）。大多数患者在因溃疡性结肠炎（38.6%）和结直肠癌（27.8%）进行初次手术后接受了袢式回肠造口术的SRs（76.5%）。与未发生SSI的患者相比，发生SSI的患者皮下引流管较少，且吸烟率、美国麻醉医师协会（ASA）3 - 4级分类以及SR时的剖腹手术率显著更高（p < 0.05）。与未发生SSI的患者相比，发生SSI的患者住院时间延长且30天发病率增加，包括败血症和返回手术室（p < 0.05）。多变量分析显示，放置皮下引流管提示对SSI有保护作用（比值比[OR] 0.52，95%置信区间[CI] 0.2 - 1.1），但只有吸烟与SSI风险增加显著相关（OR 2.4，95% CI 1.1 - 5.4）。
吸烟使患者发生SR - SSI的风险增加两倍多，且SR - SSI与其他严重疾病相关。戒烟应成为任何降低SSI风险策略的重要组成部分。
