利用全州数据库比较钝性脾损伤的再入院情况和感染性并发症

Comparing Readmissions and Infectious Complications of Blunt Splenic Injuries Using a Statewide Database.

作者信息

Olufajo Olubode A, Rios-Diaz Arturo, Peetz Allan B, Williams Katherine J, Havens Joaquim M, Cooper Zara R, Gates Jonathan D, Haider Adil H, Salim Ali, Askari Reza

机构信息

1 Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts.

2 Center for Surgery and Public Health, Brigham and Women's Hospital , Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

出版信息

Surg Infect (Larchmt). 2016 Apr;17(2):191-7. doi: 10.1089/sur.2015.137. Epub 2016 Feb 9.

DOI:10.1089/sur.2015.137

PMID:26859534

Abstract

BACKGROUND

Although non-operative management of blunt splenic injury (BSI) is increasingly common, the long-term infectious complications after adjunct splenic artery embolization (SAE) are not well described.

METHODS

Patients aged 18-64 y with BSI were identified in the California State Inpatient Database (2007-2011) and categorized as receiving either non-operative management (NOM) without SAE, NOM with SAE, or operative management (OM). The cumulative incidence of infections (surgical site infections [SSI], pneumonia, urinary tract infections, and sepsis) requiring readmission at different times up to one y after injury were calculated. Patient and treatment factors associated with infectious readmissions were determined using multivariable logistic regression models.

RESULTS

Of the 4,360 patients with BSI, 61.6% had NOM without SAE, 5.8% had NOM with SAE, and 32.6% had OM. The cumulative incidences of infectious complications after each of the management modes were 1.27%, 1.59%, and 1.76%, respectively, during admission (p = 0.446); 2.16%, 5.18%, and 4.85%, respectively, at 30 d after injury (p < 0.001); and 4.69%, 9.16%, and 8.85%, respectively, at one y after injury (p < 0.001). Risk factors for infection-associated readmissions within one y after injury were Charlson score ≥2 (adjusted odds ratio [AOR] 3.9; 95% confidence interval [CI] 2.61-6.02), length of stay >seven d (AOR 2.47; 95% CI 1.58-3.85), NOM with SAE (AOR 2.00; 95% CI 1.19-3.34), and OM (AOR 1.47; 95% CI 1.05-2.07).

CONCLUSIONS

The long-term risk of infectious complications in patients with BSI who have NOM with SAE is similar to that in patients who are treated with OM, indicating the need for pro-active strategies to reduce long-term infectious complications after SAE.

摘要

背景

尽管钝性脾损伤（BSI）的非手术治疗越来越普遍，但辅助脾动脉栓塞术（SAE）后的长期感染并发症尚未得到充分描述。

方法

在加利福尼亚州住院患者数据库（2007 - 2011年）中识别出年龄在18 - 64岁的BSI患者，并将其分为接受无SAE的非手术治疗（NOM）、有SAE的NOM或手术治疗（OM）。计算受伤后长达1年不同时间需要再次入院的感染（手术部位感染[SSI]、肺炎、尿路感染和败血症）的累积发生率。使用多变量逻辑回归模型确定与感染性再入院相关的患者和治疗因素。

结果

在4360例BSI患者中，61.6%接受无SAE的NOM，5.8%接受有SAE的NOM，32.6%接受OM。各治疗模式后感染并发症的累积发生率在入院期间分别为1.27%、1.59%和1.76%（p = 0.446）；受伤后30天时分别为2.16%、5.18%和4.85%（p < 0.001）；受伤后1年时分别为4.69%、9.16%和8.85%（p < 0.001）。受伤后1年内感染相关再入院的危险因素为Charlson评分≥2（调整优势比[AOR] 3.9；95%置信区间[CI] 2.61 - 6.02）、住院时间>7天（AOR 2.47；95% CI 1.58 - 3.85）、有SAE的NOM（AOR 2.00；95% CI 1.19 - 3.34）和OM（AOR 1.47；95% CI 1.05 - 2.07）。