Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, 6-JCP, Iowa City, IA, 52242, USA.
Department of Anesthesiology, University of Miami, Miami, FL, USA.
Can J Anaesth. 2021 Jun;68(6):812-824. doi: 10.1007/s12630-021-01931-5. Epub 2021 Feb 5.
The incidence of surgical site infection differs among operating rooms (ORs). However, cost effectiveness of interventions targeting ORs depends on infection counts. The purpose of this study was to quantify the inequality of infection counts among ORs.
We performed a single-centre historical cohort study of elective surgical cases spanning a 160-week period from May 2017 to May 2020, identifying cases of infection within 90 days using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. We used the Gini index to measure inequality of infections among ORs. As a reference, the Gini index for inequality of household disposable income in the US in 2017 was 0.39, and 0.31 for Canada.
There were 3,148 (3.67%) infections among the 85,744 cases studied. The 20% of 57 ORs with the most and least infections accounted for 44% (99% confidence interval [CI], 36 to 52) and 5% (99% CI, 2 to 8), respectively. The Gini index was 0.40 (99% CI, 0.31 to 0.50), which is comparable to income inequality in the US. There were more infections in ORs with more minutes of cases (Spearman correlation ρ = 0.68; P < 0.001), but generally not in ORs with more total cases (ρ = 0.11; P = 0.43). Moderately long (3.3 to 4.8 hr) cases had a large effect, having greater incidences of infection, while not being so long as to have just one case per day per OR. There was substantially greater inequality in infection counts among the 557 observed combinations of OR specialty (Gini index 0.85; 99% CI, 0.81 to 0.88).
Inequality of infections among ORs is substantial and caused by both inequality in the incidence of infections and inequality in the total minutes of cases. Inequality in infections among OR and specialty combinations is due principally to inequality in total minutes of cases.
手术部位感染的发生率在不同手术室（OR）之间存在差异。然而，针对 OR 进行的成本效益干预措施的效果取决于感染数量。本研究的目的是量化 OR 之间感染数量的不平等。
我们进行了一项单中心回顾性队列研究，纳入了 2017 年 5 月至 2020 年 5 月期间 160 周的择期手术病例，使用国际疾病分类，第十次修订版临床修正诊断代码在 90 天内识别感染病例。我们使用基尼指数来衡量 OR 之间感染的不平等程度。作为参考，2017 年美国家庭可支配收入不平等的基尼指数为 0.39，加拿大为 0.31。
在 85744 例研究病例中，有 3148 例（3.67%）感染。20%的 57 个 OR 中，感染数量最多和最少的 OR 分别占 44%（99%置信区间[CI]，36 至 52）和 5%（99%CI，2 至 8）。基尼指数为 0.40（99%CI，0.31 至 0.50），与美国的收入不平等程度相当。感染数量与手术时间长短（Spearman 相关系数ρ=0.68；P<0.001）相关，但与总病例数（ρ=0.11；P=0.43）无关。中等时长（3.3 至 4.8 小时）的病例感染发生率较高，但每天每个 OR 仅进行一例手术，因此并不属于长手术。在观察到的 557 个 OR 专业的组合中（基尼指数 0.85；99%CI，0.81 至 0.88），感染数量的不平等程度相当大。
OR 之间的感染不平等程度相当大，这是由感染发生率的不平等和病例总手术时间的不平等共同造成的。OR 和专业组合之间的感染不平等主要归因于病例总手术时间的不平等。
