Okui Jun, Obara Hideaki, Shimane Gaku, Sato Yasunori, Kawakubo Hirofumi, Kitago Minoru, Okabayashi Koji, Kitagawa Yuko
Department of Surgery Keio University School of Medicine Tokyo Japan.
Department of Preventive Medicine and Public Health Keio University School of Medicine Tokyo Japan.
Ann Gastroenterol Surg. 2021 Dec 21;6(3):445-453. doi: 10.1002/ags3.12539. eCollection 2022 May.
Organ/space surgical site infection (SSI) is a significant clinical problem. The postdiagnosis course of organ/space SSIs and the impact of its early diagnosis on clinical outcomes are yet to be clarified. Thus, we aimed to investigate the association between the timing of diagnosis and the clinical outcome of organ/space SSI.
This retrospective, single-center cohort study evaluated patients who underwent elective gastrointestinal or hepatopancreatobiliary surgery between 2016 and 2020. Clinical outcomes were compared between the early group (ie, SSI diagnosed until postoperative day [POD] 4) and normal-late group (ie, SSI diagnosed after POD 5). The primary outcome was the final C-reactive protein (CRP) level within 14 d after organ/space SSI diagnosis.
In total, 110 patients were evaluated. The median time of diagnosis was 7 d postoperatively (interquartile range, 5-9 d postoperatively). Compared with the normal-late group, the early group included a higher proportion of patients with Clavien-Dindo grade ≥IIIb (8/21 vs 11/89, = .01), higher final CRP value within 14 d after SSI diagnosis (mean, 4.49 mg/dL vs 2.27 mg/dL, = .01), longer postoperative length of hospitalization (median, 45.0 d vs 33.0 d; = .028), and worse 1-y overall survival rate (74.8% vs 89.3%, = .08).
Early diagnosed organ/space SSI are originally severe and may therefore be detected earlier. Importantly, early diagnosed organ/space SSI is likely to be severe and refractory.
器官/腔隙手术部位感染（SSI）是一个重大的临床问题。器官/腔隙SSI的诊断后病程及其早期诊断对临床结局的影响尚待阐明。因此，我们旨在研究诊断时机与器官/腔隙SSI临床结局之间的关联。
这项回顾性单中心队列研究评估了2016年至2020年间接受择期胃肠或肝胆胰手术的患者。比较了早期组（即SSI在术后第4天之前诊断）和正常晚期组（即SSI在术后第5天之后诊断）的临床结局。主要结局是器官/腔隙SSI诊断后14天内的最终C反应蛋白（CRP）水平。
总共评估了110例患者。诊断的中位时间为术后7天（四分位间距，术后5 - 9天）。与正常晚期组相比，早期组中Clavien-Dindo分级≥IIIb的患者比例更高（8/21对11/89，P = 0.01），SSI诊断后14天内的最终CRP值更高（平均，4.49mg/dL对2.27mg/dL，P = 0.01），术后住院时间更长（中位数，45.0天对33.0天；P = 0.028），1年总生存率更差（74.8%对89.3%，P = 0.08）。
早期诊断的器官/腔隙SSI原本病情严重，因此可能更早被发现。重要的是，早期诊断的器官/腔隙SSI可能病情严重且难治。
