结直肠、妇科肿瘤及泌尿外科手术中的腹部闭合方案：一项随机质量改进试验。
Abdominal closure protocol in colorectal, gynecologic oncology, and urology procedures: a randomized quality improvement trial.
作者信息
Kwaan Mary R, Weight Christopher J, Carda Stacy Jo, Mills-Hokanson Alyssia, Wood Elizabeth, Rivard-Hunt Colleen, Argenta Peter A
机构信息
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE MMC 450, Minneapolis, MN, 55455, USA.
Department of Urology, University of Minnesota, Minneapolis, MN, USA.
出版信息
Am J Surg. 2016 Jun;211(6):1077-83. doi: 10.1016/j.amjsurg.2015.10.032. Epub 2016 Jan 9.
BACKGROUND
Prevention of surgical site infections (SSIs) can improve surgical quality through reductions in morbidity and cost. We sought to determine whether the abdominal closure protocol, in isolation, decreases SSI at an academic teaching hospital.
METHODS
Adult patients undergoing laparotomy were prospectively randomized to an abdominal closure protocol, which includes unused sterile instruments and equipment at fascial closure, or usual care. A 30-day SSI rates were compared. General surgery, colorectal, urology, or gynecologic oncology patients undergoing anticipated wound classification II cases were eligible.
RESULTS
Overall SSI rates were 11.6% in patients randomized to protocol closure vs 12.4% for usual care (total n = 233; P = .85). The abdominal closure protocol and usual care groups had similar rates of superficial (4.5% vs 4.1%; P = .9), deep (.9% vs 0%, P = .3), organ-space SSI rates (6.2% vs 8.3%, P = .55), and wound dehiscence (2.7% vs 5.3%; P = .24).
CONCLUSIONS
An abdominal closure protocol did not decrease the rate of SSI and is likely not a key intervention for SSI reduction.
背景
预防手术部位感染（SSIs）可通过降低发病率和成本来提高手术质量。我们试图确定单纯的腹部闭合方案是否能降低一所学术教学医院的手术部位感染率。
方法
对接受剖腹手术的成年患者进行前瞻性随机分组，一组采用腹部闭合方案（包括在筋膜闭合时使用未使用过的无菌器械和设备），另一组采用常规护理。比较两组的30天手术部位感染率。纳入预计伤口分类为II类的普通外科、结直肠外科、泌尿外科或妇科肿瘤患者。
结果
随机分组至方案闭合组的患者总体手术部位感染率为11.6%，常规护理组为12.4%（总样本量n = 233；P = 0.85）。腹部闭合方案组和常规护理组在浅表手术部位感染率（4.5%对4.1%；P = 0.9）、深部手术部位感染率（0.9%对0%，P = 0.3）、器官间隙手术部位感染率（6.2%对8.3%，P = 0.55）以及伤口裂开率（2.7%对5.3%；P = 0.24）方面相似。
结论
腹部闭合方案并未降低手术部位感染率，可能不是降低手术部位感染的关键干预措施。
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