Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia; University of Queensland, School of Public Health, Herston, Brisbane, Queensland, Australia.
Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia.
J Hosp Infect. 2018 May;99(1):17-23. doi: 10.1016/j.jhin.2017.09.001. Epub 2017 Sep 7.
Infection may complicate surgical patients' hospital admission. The effect of hospital-acquired infections (HAIs) on processes of care among surgical patients who died is unknown.
To investigate the effect of HAIs on processes of care in surgical patients who died in hospital.
Surgeon-recorded infection data extracted from a national Australian surgical mortality audit (2012-2016) were grouped into HAIs and no infection. The audit included all-age surgical patients, who died in hospital. Not all patients had surgery. Excluded from analysis were patients with community-acquired infection and those with missing timing of infection. Multivariate logistic regression was used to determine the adjusted effects of HAIs on the processes of care in these patients. Costs associated with HAIs were estimated.
One-fifth of surgical patients who died did so with an HAI (2242 out of 11,681; 19.2%). HAI patients had increased processes of care compared to those who died without infection: postoperative complications [51.0% vs 30.3%; adjusted odds ratio (aOR): 2.20; 95% confidence interval (CI): 1.98-2.45; P < 0.001]; unplanned reoperations (22.6% vs 10.9%; aOR: 2.38; 95% CI: 2.09-2.71; P < 0.001) and unplanned intensive care unit admission (29.3% vs 14.8%; aOR: 2.18; 95% CI: 1.94-2.45; P < 0.001). HAI patients had longer hospital admissions and greater hospital costs than those without infection.
HAIs were associated with increased processes of care and costs in surgical patients who died; these outcomes need to be investigated in surgical patients who survive.
感染可能会使外科患者的住院治疗复杂化。医院获得性感染（HAI）对死亡外科患者护理过程的影响尚不清楚。
调查 HAI 对死亡住院外科患者护理过程的影响。
从澳大利亚全国外科死亡率审计（2012-2016 年）中提取外科医生记录的感染数据，分为 HAI 和无感染。该审计包括所有年龄的外科患者，这些患者在医院死亡。分析排除了社区获得性感染和感染时间缺失的患者。多变量逻辑回归用于确定 HAI 对这些患者护理过程的调整影响。还估计了 HAI 相关的成本。
五分之一死亡的外科患者患有 HAI（11681 例中的 2242 例，19.2%）。与无感染死亡的患者相比，HAI 患者的护理过程更多：术后并发症[51.0%比 30.3%；调整后的优势比（aOR）：2.20；95%置信区间（CI）：1.98-2.45；P<0.001]；计划外再次手术（22.6%比 10.9%；aOR：2.38；95%CI：2.09-2.71；P<0.001）和计划外重症监护病房入院（29.3%比 14.8%；aOR：2.18；95%CI：1.94-2.45；P<0.001）。HAI 患者的住院时间和住院费用均高于无感染患者。
HAI 与死亡的外科患者护理过程的增加和成本增加相关；这些结果需要在存活的外科患者中进行调查。
