Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, 4-2-1 Aoba-cho Higashimurayama, Tokyo, 189-0002, Japan.
Department of Bacteriology II, National Institute of Infectious Diseases, 4-7-1 Gakuen Musashimurayama, Tokyo, 280-0011, Japan.
BMC Infect Dis. 2021 Apr 17;21(1):363. doi: 10.1186/s12879-021-06050-6.
The association between the frequency of surgeries and the incidence of surgical site infections (SSIs) has been reported for various surgeries. However, no previous study has explored this association among video-assisted thoracic surgeries (VATS). Hence, we aimed to investigate the association between the frequency of surgeries and SSI in video-assisted thoracic surgeries.
We analyzed the data of 26,878 thoracic surgeries, including 21,154 VATS, which were collected during a national surveillance in Japan between 2014 and 2018. The frequency of surgeries per hospital department was categorized into low (< 50/year), moderate (50-100/ year), and high (> 100/year). Chi-squared test or Fisher's exact test was used for discrete explanatory variables, whereas Wilcoxon's rank-sum test or Kruskal-Wallis test was used for continuous explanatory variables. Univariate analysis of the department groups was conducted to explore confounding factors associated with both SSIs and the department groups. We used a multiple logistic regression model focusing on VATS and stratified by the National Nosocomial Infections Surveillance System (NNIS) risk index.
The rates of SSIs in the hospital groups with low, moderate, and high frequency of surgeries were 1.39, 1.05, and 1.28%, respectively. In the NNIS risk index 1 stratum, the incidence of SSIs was significantly lower in the moderate-frequency of surgeries group than that in the other groups (odds ratio [OR]: vs. low-frequency of surgeries: 2.48 [95% confidence interval [CI]: 1.20-5.13], P = 0.0143; vs. high-frequency of surgeries: 2.43 [95% CI: 1.44-4.11], P = 0.0009). In the stratum of NNIS risk indices 2 and 3, the incidence of SSI was significantly higher in the low-frequency of surgeries group (OR: 4.83, 95% CI: 1.47-15.93; P = 0.0095).
The result suggests that for departments with low-frequency of surgeries, an increase in the frequency of surgeries to > 50 per department annually potentially leads to a decrease in the incidence of SSIs. This occurs through an increase in the experience of the departmental surgeons and contributes to the improvement of VATS outcomes in thoracic surgeries.
手术频率与手术部位感染（SSI）的发生率之间的关系已在各种手术中得到报道。然而，以前的研究并未探讨胸腔镜手术（VATS）中的这种关系。因此，我们旨在研究手术频率与 VATS 中 SSI 之间的关系。
我们分析了 2014 年至 2018 年期间在日本进行的全国性监测中收集的 26878 例胸腔手术的数据，其中包括 21154 例 VATS。按医院科室手术频率分为低（<50/年）、中（50-100/年）和高（>100/年）频率。对于离散解释变量，使用卡方检验或 Fisher 确切检验，对于连续解释变量，使用 Wilcoxon 秩和检验或 Kruskal-Wallis 检验。对科室组进行单变量分析，以探讨与 SSI 和科室组相关的混杂因素。我们使用了一个针对 VATS 的多变量逻辑回归模型，并根据国家医院感染监测系统（NNIS）风险指数进行了分层。
手术频率低、中、高的医院组的 SSI 发生率分别为 1.39%、1.05%和 1.28%。在 NNIS 风险指数 1 分层中，中频率手术组 SSI 的发生率明显低于其他组（比值比[OR]：与低频率手术组相比：2.48[95%置信区间[CI]：1.20-5.13]，P=0.0143；与高频率手术组相比：2.43[95%CI：1.44-4.11]，P=0.0009）。在 NNIS 风险指数 2 和 3 的分层中，低频率手术组 SSI 的发生率明显较高（OR：4.83，95%CI：1.47-15.93；P=0.0095）。
结果表明，对于手术频率较低的科室，将手术频率增加到每年>50 次/科室可能会降低 SSI 的发生率。这是通过增加科室外科医生的经验来实现的，并有助于改善胸腔手术中的 VATS 结果。
