Sears Erika D, Momoh Adeyiza O, Chung Kevin C, Lu Yu-Ting, Zhong Lin, Waljee Jennifer F
Ann Arbor, Mich.
From the Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, and the VA Center for Clinical Management Research, VA Ann Arbor Healthcare System.
Plast Reconstr Surg. 2017 Aug;140(2):390-400. doi: 10.1097/PRS.0000000000003514.
This study aimed to evaluate the impact of delayed flap closure on mortality and resource use for treatment of deep sternal wound infection.
The authors analyzed the Truven MarketScan Databases from 2009 to 2013 to identify adult patients who developed deep sternal wound infection after open cardiac surgery and who underwent flap closure for treatment. A multivariable logistic regression model was created to evaluate the relationship between mortality and flap timing. Multivariable Poisson regressions were used to investigate the relationship between flap timing and number of procedures, number of hospitalizations, and length of stay outcomes. A multivariable log-linear regression model was created for cost analysis. All analyses were adjusted for patient risk factors and treatment characteristics.
The authors identified 612 patients with deep sternal wound infection who underwent flap closure. The timing of flap closure was delayed more than 7 days after diagnosis in 39 percent of patients. Delayed time to flap closure greater than 3 days after diagnosis of infection was associated with higher mortality odds for delay 4 to 7 days (OR, 2.94) and delay greater than 7 days (OR, 2.75; p < 0.03), greater additional procedures for delay 4 to 7 days (incidence rate ratio, 1.72) and delay greater than 7 days (incidence rate ratio, 1.93; p < 0.001), and up to 43 percent longer hospital length of stay and 37 percent greater costs compared with patients undergoing flap closure 0 to 3 days after diagnosis.
Delay in flap closure was associated with greater mortality and resource use. Prompt involvement of reconstructive surgeons may improve quality and efficiency of deep sternal wound infection care.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在评估延迟皮瓣闭合对深部胸骨伤口感染治疗的死亡率和资源利用的影响。
作者分析了2009年至2013年的Truven MarketScan数据库，以确定在心脏直视手术后发生深部胸骨伤口感染并接受皮瓣闭合治疗的成年患者。建立多变量逻辑回归模型来评估死亡率与皮瓣闭合时机之间的关系。使用多变量泊松回归来研究皮瓣闭合时机与手术次数、住院次数和住院时间结果之间的关系。创建多变量对数线性回归模型进行成本分析。所有分析均针对患者风险因素和治疗特征进行了调整。
作者确定了612例接受皮瓣闭合治疗的深部胸骨伤口感染患者。39%的患者在诊断后皮瓣闭合时间延迟超过7天。感染诊断后皮瓣闭合延迟超过3天与延迟4至7天的较高死亡几率相关（比值比，2.94），延迟超过7天的死亡几率更高（比值比，2.75；p<0.03），延迟4至7天的额外手术更多（发病率比，1.72），延迟超过7天的额外手术更多（发病率比，1.93；p<0.001），与诊断后0至3天接受皮瓣闭合的患者相比，住院时间延长多达43%，成本增加37%。
皮瓣闭合延迟与更高的死亡率和资源利用相关。重建外科医生的及时参与可能会提高深部胸骨伤口感染护理的质量和效率。
临床问题/证据水平：治疗性，III级。
