Department of Obstetrics and Gynecology, Abington Hospital-Jefferson Health, 1200 Old York Road, Price 109, Abington, PA 19001, United States.
Department of Obstetrics and Gynecology, Abington Hospital-Jefferson Health, 1200 Old York Road, Price 109, Abington, PA 19001, United States.
Gynecol Oncol. 2018 Jun;149(3):560-564. doi: 10.1016/j.ygyno.2018.03.045. Epub 2018 Mar 14.
Surgical site infections (SSI) are associated with increased morbidity, mortality, and healthcare costs. This study investigated whether implementation of an abdominal closure bundle reduces surgical site infection rates. We aimed to identify sub-populations that would benefit the most from this intervention.
We conducted a retrospective cohort study of all patients that underwent exploratory laparotomy by a Gynecologic Oncologist from January 1, 2011 to April 1, 2017. The abdominal closure bundle was implemented on May 6, 2014. SSI rates were assessed overall and within subgroups.
875 patients were included in the analysis. Overall, SSI rate was reduced, albeit not significantly, from 48/471 (10.2%) to 32/404 (7.9%) (p=0.148) with implementation of the closing bundle. In patients that underwent a tumor debulking procedure, SSI was noted in 36/277 (13.0%) in the pre-bundle group and 14/208 (6.7%) in the post-bundle cohort (p=0.017). In patients with malignant pathology, the pre-bundle cohort had an SSI rate of 38/282 (13.5%), which reduced to 18/215 (8.4%) in the post-bundle group (p=0.049). In patients with FIGO stage III or IV disease, the SSI rate was reduced from 21/114 (18.4%) to 8/87 (8.4%) with implantation of the closure bundle (p=0.028). In patients with intra-operative ascites, SSI rate decreased from 19/119 (15.9%) pre-bundle to 4/104 (3.8%) in the post-bundle group (p=0.002).
Implementation of an abdominal closure bundle was not associated with a significant reduction in overall SSI rate. However, multiple subpopulations associated with advanced gynecologic cancer benefited from this intervention.
手术部位感染（SSI）与发病率、死亡率和医疗保健成本增加有关。本研究调查了腹部闭合套件的实施是否降低了手术部位感染率。我们旨在确定最受益于这种干预的亚人群。
我们对 2011 年 1 月 1 日至 2017 年 4 月 1 日期间由妇科肿瘤学家进行的剖腹探查术的所有患者进行了回顾性队列研究。腹部闭合套件于 2014 年 5 月 6 日实施。评估了总体和亚组内的 SSI 率。
875 例患者纳入分析。总体而言，SSI 率虽有所降低，但无统计学意义，从实施闭合套件前的 471 例中的 48 例（10.2%）降至 404 例中的 32 例（7.9%）（p=0.148）。在接受肿瘤减瘤手术的患者中，在闭合套件前组中，36/277（13.0%）出现 SSI，而在闭合套件后组中，14/208（6.7%）出现 SSI（p=0.017）。在恶性病理患者中，闭合套件前组的 SSI 发生率为 282 例中的 38 例（13.5%），降至闭合套件后组的 215 例中的 18 例（8.4%）（p=0.049）。在 FIGO 分期 III 或 IV 期疾病患者中，闭合套件的实施使 SSI 率从 114 例中的 21 例（18.4%）降至 87 例中的 8 例（8.4%）（p=0.028）。在术中腹水患者中，SSI 率从闭合套件前的 119 例中的 19 例（15.9%）降至闭合套件后的 104 例中的 4 例（3.8%）（p=0.002）。
腹部闭合套件的实施并未显著降低总体 SSI 率。然而，与晚期妇科癌症相关的多个亚人群从这种干预中受益。
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