Poruk K E, Hicks C W, Trent Magruder J, Rodriguez-Unda N, Burce K K, Azoury S C, Cornell P, Cooney C M, Eckhauser F E
Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
Hernia. 2017 Apr;21(2):261-269. doi: 10.1007/s10029-016-1547-x. Epub 2016 Dec 18.
Complex ventral hernia repair (VHR) is a common surgical operation but carries a risk of complications from surgical site infections (SSI) and occurrences (SSO). We aimed to create a predictive risk score to identify patients at increased risk for SSO or SSI within 30 days of surgery.
Data were prospectively collected on all patients undergoing VHR between January 2008 and February 2015 by a single surgeon. Multivariable logistic regression was used to identify independent factors predictive of SSO and SSI. Significant predictors of SSO and SSI were assigned point values based on their odds ratios to create a novel risk score, the Hopkins ventral hernia repair SSO/SSI risk score; predicted and actual rates of outcomes were then compared using weighted regression.
During the study period, 362 patients underwent open VHR. Thirty-day SSO and SSI occurred in 18.5 and 10% of patients, respectively. After risk adjustment, ASA class ≥3 (1 point), operative time ≥4 h (2 points), and the absence of a postoperative wound vacuum dressing (1 point) were predictive of 30-day SSO. Predicted risk of SSO utilizing this scoring system was 9.7, 19.4, 29.1, and 38.8% for 1, 2, 3, and 4 points (AUC = 0.73). For SSI, operative time ≥4 h (1 point) and the lack of a wound vacuum dressing (1 point) were predictive. Predicted risk of SSI based on this scoring system was 12.5% for 1 point and 25% for 2 points (AUC = 0.71). Actual vs. predicted rates of SSO and SSI correlated strongly for risk model with a coefficient of determination (R ) of 0.92 and 0.91, respectively.
The novel Hopkins ventral hernia repair risk score accurately predicts risk of SSO and SSI after complex VHR. Further studies using a prospective randomized controlled trial will be needed to further validate our findings.
复杂腹疝修补术（VHR）是一种常见的外科手术，但存在手术部位感染（SSI）和手术部位并发症（SSO）的风险。我们旨在创建一个预测风险评分，以识别手术30天内发生SSO或SSI风险增加的患者。
由一名外科医生前瞻性收集2008年1月至2015年2月期间所有接受VHR的患者的数据。采用多变量逻辑回归来识别预测SSO和SSI的独立因素。根据SSO和SSI的显著预测因素的优势比赋予分值，以创建一个新的风险评分，即霍普金斯腹疝修补术SSO/SSI风险评分；然后使用加权回归比较预测和实际的结局发生率。
在研究期间，362例患者接受了开放性VHR。30天SSO和SSI的发生率分别为18.5%和10%。风险调整后，美国麻醉医师协会（ASA）分级≥3（1分）、手术时间≥4小时（2分）以及术后未使用伤口负压敷料（1分）可预测30天SSO。使用该评分系统，1分、2分、3分和4分的SSO预测风险分别为9.7%、19.4%、29.1%和38.8%（曲线下面积[AUC]=0.73）。对于SSI，手术时间≥4小时（1分）和未使用伤口负压敷料（1分）可预测。基于该评分系统，1分的SSI预测风险为12.5%，2分的为25%（AUC=0.71）。风险模型的SSO和SSI实际发生率与预测发生率密切相关，决定系数（R）分别为0.92和0.91。
新的霍普金斯腹疝修补术风险评分准确预测了复杂VHR术后的SSO和SSI风险。需要使用前瞻性随机对照试验进行进一步研究以进一步验证我们的发现。
