Schiavone Maria B, Moukarzel Lea, Leong Kam, Zhou Qin C, Afonso Anoushka M, Iasonos Alexia, Roche Kara Long, Leitao Mario M, Chi Dennis S, Abu-Rustum Nadeem R, Zivanovic Oliver
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Gynecol Oncol. 2017 Oct;147(1):115-119. doi: 10.1016/j.ygyno.2017.07.010. Epub 2017 Jul 19.
Surgical site infections (SSIs) can lead to substantial morbidity, prolonged hospitalization, increased costs, and death in patients undergoing colorectal procedures. We sought to investigate the effect of using an SSI reduction bundle on the rate of SSIs in gynecologic cancer patients undergoing colon surgery.
We identified all gynecologic cancer patients who underwent colon resection at our institution from 2014 to 2016, during which time a service-wide SSI reduction bundle was introduced. The intervention included preoperative oral antibiotics with optional mechanical bowel preparation, skin preparation with antibacterial solution, and the use of a separate surgical closing tray. SSI rates were assessed within 30days post-surgery.
Of 233 identified patients, 115 had undergone colon surgery prior to (PRE) and 118 after (POST) the implementation of the intervention. A low anterior resection was the most common colon surgery in both cohorts. The incidence of SSI within 30days of surgery was 43/115 (37%) in the PRE and 14/118 (12%) in the POST cohorts (p≤0.001). Wound dehiscence was noted in 30/115 (26%) and 2/118 (2%) patients, respectively (p≤0.001). In patients whose operation took longer than 360min, 30-day SSI rates were 37% (28/76) and 12% (8/67), respectively (p≤0.001). In patients with an estimated blood loss >500cm, SSI rates were 44% (27/62) and 15% (10/67), respectively (p≤0.001).
The implementation of an SSI reduction bundle was associated with a significant reduction in 30-day SSIs in these patients. The intervention remained effective in patients undergoing longer operations and in those with increased blood loss.
手术部位感染（SSIs）可导致接受结直肠手术的患者出现严重发病情况、住院时间延长、费用增加及死亡。我们旨在研究采用手术部位感染减少综合措施对接受结肠手术的妇科癌症患者手术部位感染发生率的影响。
我们确定了2014年至2016年在本机构接受结肠切除术的所有妇科癌症患者，在此期间引入了全院范围的手术部位感染减少综合措施。干预措施包括术前口服抗生素并可选择机械肠道准备、用抗菌溶液进行皮肤准备以及使用单独的手术闭合托盘。在术后30天内评估手术部位感染发生率。
在确定的233例患者中，115例在干预措施实施前（PRE）接受了结肠手术，118例在实施后（POST）接受了结肠手术。低位前切除术是两个队列中最常见的结肠手术。手术前队列中术后30天内手术部位感染发生率为43/115（37%），术后队列中为14/118（12%）（p≤0.001）。分别有30/115（26%）和2/118（2%）的患者出现伤口裂开（p≤0.001）。手术时间超过360分钟的患者，30天手术部位感染发生率分别为37%（28/76）和12%（8/67）（p≤0.001）。估计失血量>500cm的患者，手术部位感染发生率分别为44%（27/62）和15%（10/67）（p≤0.001）。
实施手术部位感染减少综合措施与这些患者术后30天手术部位感染显著减少相关。该干预措施在手术时间较长和失血较多的患者中仍然有效。
