Gonzalez Dani O, Ambeba Erica, Minneci Peter C, Deans Katherine J, Nwomeh Benedict C
Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
J Surg Res. 2017 Mar;209:234-241. doi: 10.1016/j.jss.2016.10.029. Epub 2016 Nov 4.
Surgical site infection (SSI) is a burdensome complication following intestinal stoma closure, with reported rates ranging from 0% to 40%. We aimed to identify risk factors for SSI in children undergoing stoma closure.
Using 2012-2014 NSQIP Pediatric data, we identified patients aged 0-18 years undergoing stoma closure. Demographic, clinical, and 30-day outcome characteristics between children with and without SSI were compared. A multivariable logistic model was used to identify predictors of SSI.
Among 2110 children who underwent stoma closure, 7.6% developed SSI. Patients who developed SSI had significantly longer time in the operating room, longer anesthesia times, longer total operation times, and longer lengths of stay (all P ≤ 0.01). Patients who developed SSI postoperatively had significantly higher rates of postoperative complications, including need for postoperative ventilation, sepsis, need for nutritional support on discharge, unplanned reoperation, unplanned readmission, postoperative lengths of stay >30 days, and transfusion within 72 hours after the start of surgery (all P ≤ 0.018). There was a significant relationship between operation time and SSI probability. Specifically, operation time greater than 105 minutes was associated with a higher SSI risk. On adjusted multivariable analyses, age, cardiac risk factors, Hirschsprung disease, and operation time greater than 105 minutes were independently predictive of SSI.
Longer operation time, age, Hirschsprung disease, and cardiac risk factors are associated with an increased risk for SSI after stoma closure. Studies of perioperative adjuncts to reduce SSI in high-risk children based on expected procedure length and other preoperative characteristics are warranted.
手术部位感染（SSI）是肠造口关闭术后的一种严重并发症，报道的发生率在0%至40%之间。我们旨在确定接受造口关闭术儿童发生SSI的危险因素。
利用2012 - 2014年国家外科质量改进计划（NSQIP）儿科数据，我们确定了年龄在0 - 18岁接受造口关闭术的患者。比较了发生SSI和未发生SSI儿童的人口统计学、临床和30天结局特征。采用多变量逻辑模型确定SSI的预测因素。
在2110例接受造口关闭术的儿童中，7.6%发生了SSI。发生SSI的患者在手术室的时间、麻醉时间、总手术时间和住院时间均显著更长（所有P≤0.01）。术后发生SSI的患者术后并发症发生率显著更高，包括术后通气需求、败血症、出院时营养支持需求、计划外再次手术、计划外再次入院、术后住院时间>30天以及手术开始后72小时内输血（所有P≤0.018）。手术时间与SSI发生概率之间存在显著关系。具体而言，手术时间大于105分钟与更高的SSI风险相关。在调整后的多变量分析中，年龄、心脏危险因素、先天性巨结肠病以及手术时间大于105分钟是SSI的独立预测因素。
手术时间延长、年龄、先天性巨结肠病和心脏危险因素与造口关闭术后SSI风险增加相关。基于预期手术时长和其他术前特征，对高危儿童围手术期辅助措施以降低SSI进行研究是有必要的。
