Prabhu Ajita S, Krpata David M, Phillips Sharon, Huang Li-Ching, Haskins Ivy N, Rosenblatt Steven, Poulose Benjamin K, Rosen Michael J
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.
J Am Coll Surg. 2017 Mar;224(3):334-340. doi: 10.1016/j.jamcollsurg.2016.12.013. Epub 2016 Dec 23.
There is varying evidence about the use of preoperative chlorhexidine gluconate to decrease surgical site infection for elective surgery. This intervention has never been studied in ventral hernia repair, the most common general surgery procedure in the US. We aimed to determine whether preoperative chlorhexidine gluconate decreases the risk of 30-day wound morbidity in patients undergoing ventral hernia repair.
All patients undergoing ventral hernia repair in the Americas Hernia Society Quality Collaborative were separated into 2 groups: 1 group received preoperative chlorhexidine scrub and the other did not. The 2 groups were evaluated for 30-day wound morbidity, including surgical site occurrence (SSO), surgical site infection (SSI), and SSO requiring procedural intervention. Statistical analysis was performed using multivariate regression analysis and propensity score modeling. Multiple factors were controlled for statistical analysis, including patient-related factors and operative factors.
In total, 3,924 patients were included for comparison. After multivariate logistic regression modeling, the preoperative chlorhexidine scrub group had a higher incidence of SSOs (odds ratio [OR] = 1.34; 95% CI 1.11 to 1.61) and SSIs (OR = 1.46; 95% CI 1.03 to 2.07). After propensity score modeling, the increased risk of SSO and SSI persisted (SSO: OR = 1.39; 95% CI 1.15 to 1.70; SSI: OR = 1.45; 95% CI 1.011 to 2.072, respectively).
Prehospital chlorhexidine gluconate scrub appears to increase the risk of 30-day wound morbidity in patients undergoing ventral hernia repair. These findings suggest that the generalized use of prehospital chlorhexidine might not be desirable for all surgical populations.
关于术前使用葡萄糖酸氯己定以降低择期手术手术部位感染的证据不一。在美国最常见的普通外科手术——腹疝修补术中，从未对这种干预措施进行过研究。我们旨在确定术前葡萄糖酸氯己定是否能降低接受腹疝修补术患者30天伤口发病风险。
美洲疝学会质量协作组中所有接受腹疝修补术的患者被分为两组：一组接受术前氯己定擦洗，另一组未接受。对两组患者进行30天伤口发病情况评估，包括手术部位事件（SSO）、手术部位感染（SSI）以及需要进行手术干预的SSO。使用多因素回归分析和倾向评分模型进行统计分析。统计分析中控制了多个因素，包括患者相关因素和手术因素。
总共纳入3924例患者进行比较。经过多因素逻辑回归建模，术前氯己定擦洗组的SSO发生率更高（比值比[OR]=1.34；95%可信区间1.11至1.61），SSI发生率也更高（OR=1.46；95%可信区间1.03至2.07）。经过倾向评分建模后，SSO和SSI的风险增加仍然存在（SSO：OR=1.39；95%可信区间1.15至1.70；SSI：OR=1.45；95%可信区间1.011至2.072）。
院前葡萄糖酸氯己定擦洗似乎会增加接受腹疝修补术患者30天伤口发病风险。这些发现表明，并非所有手术人群都适合普遍使用院前氯己定。
