Department of General and Gastrointestinal Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Maharajgung, Kathmandu, Nepal.
Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
BMC Surg. 2021 Jan 4;21(1):6. doi: 10.1186/s12893-020-01029-7.
Incisional surgical site infection (SSI) is a significant source of postoperative morbidity resulting in increased length of stay and cost. In this study, our aim was to evaluate the association between thickness of subcutaneous fat (TSF) and incisional SSI among patients undergoing open appendectomy in low-resource settings.
90 patients with acute uncomplicated appendicitis who underwent emergency open appendectomy from December 2017 to August 2018 were included in this prospective study. TSF was measured preoperatively using ultrasound. TSF and other possible predictors of incisional SSI, including body mass index and other clinical characteristics, were assessed by univariate and multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of TSF and the optimum cut-off value for TSF was determined using the Youden index.
The prevalence of incisional SSI was 13.3% (12/90). TSF was independently associated with incisional SSI (P < 0.001). Additionally, history of smoking (P = 0.048) was also associated with incisional SSI. A model of incisional SSI using a cut-off of 23.0 mm for TSF was moderately accurate (area under curve 0.83, confidence interval 0.70-0.97; sensitivity 83.3%; specificity 76.9%).
The study demonstrated that TSF, as evaluated by ultrasound, is a predictor in the development of incisional SSI in patients with acute appendicitis undergoing open appendectomy. These findings suggest that ultrasound is useful both for the evaluation of TSF and the prediction of incisional SSI risk factor in low-resource settings.
切口手术部位感染（SSI）是导致术后发病率增加、住院时间延长和费用增加的一个重要来源。在这项研究中，我们的目的是评估在资源匮乏环境下接受开放性阑尾切除术的患者中，皮下脂肪厚度（TSF）与切口 SSI 之间的关系。
本前瞻性研究纳入了 2017 年 12 月至 2018 年 8 月期间因急性单纯性阑尾炎而行急诊开放性阑尾切除术的 90 例患者。术前使用超声测量 TSF。通过单变量和多变量逻辑回归分析评估 TSF 与切口 SSI 的其他可能预测因素，包括体重指数和其他临床特征。接受者操作特征（ROC）曲线分析评估 TSF 的预测价值，并使用约登指数确定 TSF 的最佳截断值。
切口 SSI 的患病率为 13.3%（12/90）。TSF 与切口 SSI 独立相关（P<0.001）。此外，吸烟史（P=0.048）也与切口 SSI 相关。使用 TSF 截断值 23.0mm 的切口 SSI 模型具有中等准确性（曲线下面积 0.83，置信区间 0.70-0.97；敏感度 83.3%；特异性 76.9%）。
该研究表明，超声评估的 TSF 是急性阑尾炎患者接受开放性阑尾切除术时切口 SSI 发展的预测因素。这些发现表明，超声在评估 TSF 和预测资源匮乏环境下切口 SSI 风险因素方面均具有一定价值。
