开腹与腹腔镜结肠切除术术后手术部位感染的危险因素：一项队列研究。
Risk factors for surgical site infections following open versus laparoscopic colectomies: a cohort study.
机构信息
Infectious Diseases Unit, Meir medical Center, Kfar-Saba, Israel.
Infection Control Unit, Meir medical Center, Kfar-Saba, Israel.
出版信息
BMC Surg. 2021 Oct 25;21(1):376. doi: 10.1186/s12893-021-01379-w.
BACKGROUND
Surgical site infections (SSIs) are among the most common healthcare-associated infections. Evaluating risk factors for SSIs among patients undergoing laparoscopic and open colorectal resections can aid in selecting appropriate candidates for each modality.
METHODS
A cohort of all consecutive patients undergoing elective colorectal resections during 2008-2017 in a single center was analyzed. SSIs were prospectively assessed by infection control personnel. Patient data were collected from electronic medical records. Risk factors for SSIs were compared between patients who underwent laparoscopic and open surgeries. A multivariate analysis was performed for significant variables.
RESULTS
During the study period, 865 patients underwent elective colorectal resection: 596 laparoscopic and 269 open surgeries. Mean age was 68.2 ± 15.1 years, weight 72.5 ± 18.3 kg and 441 (51%) were men. The most common indication for surgery was malignancy, in 767 patients (88.7%) with inflammatory bowel diseases and diverticulitis following (4.5% and 3.9%, respectively). Patients undergoing laparoscopic surgery were younger, had fewer comorbidities, shorter pre-operative hospitalizations, lower risk index scores, and lower rates of SSI, compared with open surgery. Independent risk factors for SSI following laparoscopic surgery were chronic obstructive pulmonary disease [odds ratio (OR) 2.655 95% CI (1.267, 5.565)], risk index ≥ 2 [OR 2.079, 95% CI (1.041,4.153)] and conversion of laparoscopic to open surgery [OR 2.056 95%CI (1.212, 3.486)]. Independent risk factors for SSI following open surgery were immunosuppression [OR 3.378 95% CI (1.071, 10.655)], chronic kidney disease [OR 2.643 95% CI (1.008, 6.933)], and need for a second dose of prophylactic antibiotics [OR 2.519 95%CI (1.074, 5.905)].
CONCLUSIONS
Risk factors for SSIs differ between laparoscopic and open colorectal resections. Knowledge of specific risk factors may inform patient selection for these modalities.
背景
手术部位感染（SSI）是最常见的与医疗保健相关的感染之一。评估接受腹腔镜和开腹结直肠切除术的患者发生 SSI 的风险因素有助于为每种手术方式选择合适的人选。
方法
对 2008 年至 2017 年在一个中心连续进行的所有择期结直肠切除术患者进行了队列分析。感染控制人员通过前瞻性评估 SSI。从电子病历中收集患者数据。比较接受腹腔镜和开腹手术的患者的 SSI 风险因素。对有意义的变量进行多变量分析。
结果
在研究期间，865 名患者接受了择期结直肠切除术：596 例腹腔镜手术和 269 例开腹手术。平均年龄为 68.2±15.1 岁，体重为 72.5±18.3kg，441 名（51%）为男性。手术最常见的指征是恶性肿瘤，767 例（88.7%）为炎症性肠病和憩室炎，分别为 4.5%和 3.9%。与开腹手术相比，接受腹腔镜手术的患者年龄较小、合并症较少、术前住院时间较短、风险指数评分较低，SSI 发生率较低。腹腔镜手术后 SSI 的独立危险因素是慢性阻塞性肺疾病[比值比（OR）2.655，95%置信区间（CI）（1.267，5.565）]、风险指数≥2[OR 2.079，95%CI（1.041，4.153）]和腹腔镜转为开腹手术[OR 2.056，95%CI（1.212，3.486）]。开腹手术后 SSI 的独立危险因素是免疫抑制[OR 3.378，95%CI（1.071，10.655）]、慢性肾脏病[OR 2.643，95%CI（1.008，6.933）]和需要第二次预防性抗生素剂量[OR 2.519，95%CI（1.074，5.905）]。
结论
腹腔镜和开腹结直肠切除术的 SSI 危险因素不同。了解特定的危险因素可能有助于为这些手术方式选择患者。
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