术前肠道准备能否降低择期腹疝修补术中手术部位感染的发生率？
Does Preoperative Bowel Preparation Reduce Surgical Site Infections During Elective Ventral Hernia Repair?
作者信息
Krpata David M, Haskins Ivy N, Phillips Sharon, Prabhu Ajita S, Rosenblatt Steven, Poulose Benjamin K, Rosen Michael J
机构信息
Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH.
Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH.
出版信息
J Am Coll Surg. 2017 Feb;224(2):204-211. doi: 10.1016/j.jamcollsurg.2016.10.049. Epub 2016 Nov 4.
BACKGROUND
To date, little is known about the benefits of preoperative bowel preparation in patients undergoing elective ventral hernia repair (VHR). The purpose of this study was to determine the effect of preoperative bowel preparation on 30-day wound events in patients undergoing elective VHR using the Americas Hernia Society Quality Collaborative (AHSQC).
STUDY DESIGN
All patients undergoing elective VHR from January 2013 through January 2016 were identified within the AHSQC. Patients undergoing emergency VHR and those with a CDC wound class IV were excluded from our analysis. Patients were divided into 2 groups: Clean (CDC wound class I) and Contaminated (CDC wound classes II and III). The association of preoperative bowel preparation with 30-day wound events was investigated using logistic regression modeling.
RESULTS
A total of 3,709 patients met inclusion criteria; 3,101 (83.6%) had CDC wound class I, and 608 (16.4%) had CDC wound classes II or III. Within the Clean group, patients who underwent preoperative bowel preparation were significantly more likely to experience a surgical site infection (SSI), surgical site occurrence (SSO), and surgical site occurrence requiring procedural intervention (SSOPI). Within the Contaminated group, patients who underwent preoperative bowel preparation were significantly more likely to experience an SSOPI.
CONCLUSIONS
The use of preoperative bowel preparation in patients undergoing elective VHR does not reduce the risk of 30-day wound events.
背景
迄今为止，对于接受择期腹疝修补术（VHR）的患者，术前肠道准备的益处鲜为人知。本研究的目的是利用美国疝学会质量协作组织（AHSQC）的数据，确定术前肠道准备对接受择期VHR患者30天伤口事件的影响。
研究设计
在AHSQC中识别出2013年1月至2016年1月期间所有接受择期VHR的患者。急诊VHR患者和疾病控制与预防中心（CDC）伤口分类为IV级的患者被排除在我们的分析之外。患者分为两组：清洁组（CDC伤口分类为I级）和污染组（CDC伤口分类为II级和III级）。使用逻辑回归模型研究术前肠道准备与30天伤口事件的相关性。
结果
共有3709例患者符合纳入标准；3101例（83.6%）为CDC伤口分类I级，608例（16.4%）为CDC伤口分类II级或III级。在清洁组中，接受术前肠道准备的患者发生手术部位感染（SSI）、手术部位事件（SSO）和需要进行手术干预的手术部位事件（SSOPI）的可能性显著更高。在污染组中，接受术前肠道准备的患者发生SSOPI的可能性显著更高。
结论
在接受择期VHR的患者中使用术前肠道准备并不能降低30天伤口事件的风险。
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