Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston.
JAMA Surg. 2017 Jul 1;152(7):686-690. doi: 10.1001/jamasurg.2017.0505.
Surgical site infections (SSIs) feature prominently in surgical quality improvement and pay-for-performance measures. Multiple approaches are used to prevent or reduce SSIs, prompted by the heavy toll they take on patients and health care budgets. Surgery for colon cancer is not an exception.
To identify a risk stratification score based on baseline and operative characteristics.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included all patients treated surgically for colon cancer at Massachusetts General Hospital from 2004 through 2014 (n = 1481).
The incidence of SSI stratified over baseline and perioperative factors was compared and compounded in a risk score.
Among the 1481 participants, 90 (6.1%) had SSI. Median (IQR) age was 66.9 (55.9-78.1) years. Surgical site infection rates were significantly higher among people who smoked (7.4% vs 4.8%; P = .04), people who abused alcohol (10.6% vs 5.7%; P = .04), people with type 2 diabetics (8.8% vs 5.5%; P = .046), and obese patients (11.7% vs 4.0%; P < .001). Surgical site infection rates were also higher among patients with an operation duration longer than 140 minutes (7.5% vs 5.0%; P = .05) and in nonlaparoscopic approaches (clinically significant only, 6.7% vs 4.1%; P = .07). These risk factors were also associated with an increase in SSI rates as a compounded score (P < .001). Patients with 1 or fewer risk factors (n = 427) had an SSI rate of 2.3%, equivalent to a relative risk of 0.4 (95% CI, 0.16-0.57; P < .001); patients with 2 risk factors (n = 445) had a 5.2% SSI rate (relative risk, 0.78; 95% CI, 0.49-1.22; P = .27); patients with 3 factors (n = 384) had a 7.8% SSI rate (relative risk, 1.38; 95% CI, 0.91-2.11; P = .13); and patients with 4 or more risk factors (n = 198) had a 13.6% SSI rate (relative risk, 2.71; 95% CI, 1.77-4.12; P < .001).
This SSI risk assessment factor provides a simple tool using readily available characteristics to stratify patients by SSI risk and identify patients at risk during their postoperative admission. Thereby, it can be used to potentially focus frequent monitoring and more aggressive preventive efforts on high-risk patients.
手术部位感染（SSI）在外科质量改进和按绩效付费措施中占据重要地位。由于它们给患者和医疗保健预算带来了沉重的负担，因此有多种方法用于预防或减少 SSI。结肠癌手术也不例外。
基于基线和手术特征，确定一种风险分层评分。
设计、设置和参与者：本回顾性队列研究纳入了 2004 年至 2014 年期间在马萨诸塞州综合医院接受结肠癌手术治疗的所有患者（n=1481）。
比较了基于基线和围手术期因素的 SSI 分层发生率，并在风险评分中进行了复合。
在 1481 名参与者中，90 名（6.1%）发生 SSI。中位（IQR）年龄为 66.9（55.9-78.1）岁。与不吸烟的患者相比，吸烟者（7.4%比 4.8%；P=.04）、酗酒者（10.6%比 5.7%；P=.04）、2 型糖尿病患者（8.8%比 5.5%；P=.046）和肥胖患者（11.7%比 4.0%；P<.001）的 SSI 发生率显著更高。手术时间超过 140 分钟的患者（7.5%比 5.0%；P=.05）和非腹腔镜方法的患者（仅临床显著，6.7%比 4.1%；P=.07）的 SSI 发生率也更高。这些危险因素也与复合评分后的 SSI 发生率增加相关（P<.001）。有 1 个或更少危险因素的患者（n=427）的 SSI 发生率为 2.3%，相对风险为 0.4（95%CI，0.16-0.57；P<.001）；有 2 个危险因素的患者（n=445）的 SSI 发生率为 5.2%（相对风险，0.78；95%CI，0.49-1.22；P=.27）；有 3 个危险因素的患者（n=384）的 SSI 发生率为 7.8%（相对风险，1.38；95%CI，0.91-2.11；P=.13）；有 4 个或更多危险因素的患者（n=198）的 SSI 发生率为 13.6%（相对风险，2.71；95%CI，1.77-4.12；P<.001）。
这种 SSI 风险评估因素提供了一种简单的工具，使用现成的特征对患者进行 SSI 风险分层，并在术后住院期间识别出风险患者。因此，它可用于潜在地将频繁监测和更积极的预防措施集中在高风险患者身上。
