Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, UCONN Health, Farmington, CT; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO.
Surgery. 2021 Feb;169(2):325-332. doi: 10.1016/j.surg.2020.08.009. Epub 2020 Sep 12.
Postoperative complications, length of index hospital stay, and unplanned hospital readmissions are important metrics reflecting surgical care quality. Postoperative infections represent a substantial proportion of all postoperative complications. We examined the relationships between identification of postoperative infection prehospital and posthospital discharge, length of stay, and unplanned readmissions in the American College of Surgeons National Surgical Quality Improvement Program database across nine surgical specialties.
The 30-day postoperative infectious complications including sepsis, surgical site infections, pneumonia, and urinary tract infection were analyzed in the American College of Surgeons National Surgical Quality Improvement Program inpatient data during the period from 2012 to 2017. General, gynecologic, vascular, orthopedic, otolaryngology, plastic, thoracic, urologic, and neurosurgical inpatient operations were selected.
Postoperative infectious complications were identified in 5.2% (137,014/2,620,450) of cases; 81,929 (59.8%) were postdischarge. The percentage of specific complications identified postdischarge were 73.4% of surgical site infections (range across specialties 63.7-93.1%); 34.9% of sepsis cases (27.4-58.1%); 26.5% of pneumonia cases (18.9%-36.3%); and 53.2% of urinary tract infections (48.3%-88.0%). The relative risk of readmission among patients with postdischarge versus predischarge surgical site infection, sepsis, pneumonia, or urinary tract infection was 5.13 (95% confidence interval: 4.90-5.37), 9.63 (8.93-10.40), 10.79 (10.15-11.45), and 3.32 (3.07-3.60), respectively. Over time, mean length of stay decreased but postdischarge infections and readmission rates significantly increased.
Most postoperative infectious complications were diagnosed postdischarge. These were associated with an increased risk of readmission. The trend toward shorter length of stay over time was observed along with an increase both in the percentage of infections detected after discharge and the rate of unplanned related postoperative readmissions over time. Postoperative surveillance of infections should extend beyond hospital discharge of surgical patients.
术后并发症、住院时间和非计划性住院再入院是反映手术护理质量的重要指标。术后感染是所有术后并发症的重要组成部分。我们在美国外科医师学会国家手术质量改进计划数据库中检查了 9 个外科专业中术前和术后出院时识别术后感染、住院时间和非计划性再入院之间的关系。
在 2012 年至 2017 年期间，对美国外科医师学会国家手术质量改进计划住院患者数据中 30 天内的术后感染性并发症（包括败血症、手术部位感染、肺炎和尿路感染）进行了分析。选择普外科、妇科、血管外科、骨科、耳鼻喉科、整形外科、胸外科、泌尿科和神经外科的住院手术。
术后感染性并发症在 2620450 例病例中占 5.2%（137014 例）；81929 例（59.8%）为出院后。出院后识别出的特定并发症比例分别为：手术部位感染 73.4%（各专业范围为 63.7%-93.1%）；败血症 34.9%（27.4%-58.1%）；肺炎 26.5%（18.9%-36.3%）；尿路感染 53.2%（48.3%-88.0%）。与术前相比，出院后发生手术部位感染、败血症、肺炎或尿路感染的患者再入院的相对风险分别为 5.13（95%置信区间：4.90-5.37）、9.63（8.93-10.40）、10.79（10.15-11.45）和 3.32（3.07-3.60）。随着时间的推移，平均住院时间缩短，但出院后感染和再入院率显著增加。
大多数术后感染性并发症在出院后诊断。这些并发症与再入院风险增加有关。随着时间的推移，住院时间缩短的趋势明显，同时出院后发现的感染百分比和非计划性术后相关再入院率也在增加。对手术患者的感染监测应延长至出院后。
