Division of Gynecologic Oncology, Wake Forest School of Medicine, Winston Salem, USA.
Department of Obstetrics and Gynecology, The Ohio State University, Columbus, USA.
Gynecol Oncol. 2022 Jul;166(1):69-75. doi: 10.1016/j.ygyno.2022.04.020. Epub 2022 May 5.
To determine rates of surgical site infection (SSI) with and without an abdominal closure protocol for gynecologic oncology patients undergoing abdominal hysterectomy.
Consecutive patients were identified using CPT codes who underwent total abdominal hysterectomy by gynecologic oncologists at a tertiary care center from January 1, 2015 to December 31, 2019, and stratified by use of the abdominal closure protocol. Demographic, perioperative, and pathologic variables were collected. Fisher's exact and Chi squared tests were used for categorical variables, logistic regression and student t-tests for continuous variables. Multiple logistic regression was used to analyze the relationships between these variables, use of the closure protocol, and development of SSI.
739 patients were included over the study period (n = 393 pre-implementation, n = 346 post-implementation of the abdominal closure protocol,). Baseline demographics including ASA score, BMI, diabetes, and smoking were similar between these groups (P = 0.14-0.94). The rate of SSI within 30 days was 5.9% (23/393) in the pre-protocol group and 8.1% (28/346) under the abdominal closure protocol (P = 0.25). On univariate analysis, factors associated with SSI were BMI >40, diabetes, bowel resection, ASA score 3 or 4, hypertension, and contaminated wound class (uOR 2.31-4.09). On multivariate analysis BMI >40, diabetes, and bowel resection remained independent risk factors (aOR 2.27-2.99), with the closure protocol not achieving significance (aOR 1.43, 95% CI 0.79-2.59). There were no potentially high-risk sub-groups in whom the closing protocol showed benefit.
The abdominal closure protocol in isolation did not decrease SSI in those undergoing TAH by a gynecologic oncologist.
确定妇科肿瘤患者行全子宫切除术时使用和不使用腹部闭合协议的手术部位感染（SSI）发生率。
使用 CPT 代码识别 2015 年 1 月 1 日至 2019 年 12 月 31 日在三级医疗中心接受妇科肿瘤医生全子宫切除术的连续患者，并按腹部闭合协议的使用情况进行分层。收集人口统计学、围手术期和病理变量。使用 Fisher's 确切检验和卡方检验进行分类变量分析，使用逻辑回归和学生 t 检验进行连续变量分析。多因素逻辑回归用于分析这些变量、使用闭合协议和发生 SSI 之间的关系。
在研究期间纳入了 739 名患者（实施前协议组 n = 393，实施后协议组 n = 346）。两组的基线人口统计学特征，包括 ASA 评分、BMI、糖尿病和吸烟，差异无统计学意义（P = 0.14-0.94）。在预协议组中，30 天内 SSI 的发生率为 5.9%（23/393），在腹部闭合协议组中为 8.1%（28/346）（P = 0.25）。单因素分析显示，与 SSI 相关的因素包括 BMI >40、糖尿病、肠切除术、ASA 评分 3 或 4、高血压和污染伤口分级（uOR 2.31-4.09）。多因素分析显示，BMI >40、糖尿病和肠切除术仍然是独立的危险因素（aOR 2.27-2.99），而闭合协议没有统计学意义（aOR 1.43，95%CI 0.79-2.59）。没有潜在的高危亚组表明闭合协议有益。
在妇科肿瘤医生行全子宫切除术时，单独使用腹部闭合协议并不能降低 SSI 的发生率。
