Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy.
Department of Vascular Surgery, University Hospital and Trust of Verona, Italy.
Ann Vasc Surg. 2023 Feb;89:60-67. doi: 10.1016/j.avsg.2022.09.065. Epub 2022 Oct 28.
The aim of this study was to evaluate whether the scrupulous hygiene rules and the restriction of contacts during the lockdown owing to the COVID-19 pandemic affected the rate and severity of surgical site infections (SSI) after vascular exposure in the groin at two Italian University Hospitals.
Starting from March 2020, strict hygiene measures for protection of health care workers (HCW) and patients from COVID-19 infection were implemented, and partly lifted in July 2020. The main exposure for analysis purposes was the period in which patients were operated. Accordingly, study subjects were divided into two groups for subsequent comparisons (preCOVID-19 era: March-June 2018-2019 versus COVID-19 era: March-June 2020). The primary endpoint was the occurrence of superficial and/or deep SSI within 30 days after surgery. The Centers for Disease Control and Prevention definitions were used to classify superficial and deep SSI.
A total of 194 consecutive patients who underwent vascular exposure in the groin were retrospectively analyzed. Of those, 60 underwent surgery from April 1, 2018 to June 30 of the same year; 83 from April 1, 2019 to June 30 of the same year; and 51 from April 1, 2020 to June 30 of the same year. The mean age of the study cohort was 75 years and 140 (72%) were males. Patients who were operated in the COVID-19 era were less likely to develop SSI (10% vs. 28%; P = 0.008), including both deep SSI (4% vs. 13%; P = 0.04) and superficial SSI (6% vs. 15%; P = 0.05). After multivariate adjustments, being operated in the COVID-19 era was found to be a negative predictor for development of an SSI (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.09-0.76; P < 0.001) or deep SSI (OR = 0.21; 95% CI = 0.03-0.98; P < 0.001). Operative time was also found as independent predictor for the development of deep SSI (OR = 1.21; 95%CI = 1.21-1.52; P = 0.02). Using binary logistic regression, there were no independent predictors of superficial SSI that could be identified.
Vascular exposure in the groin carries a non-negligible risk of SSI. In this study, we provided important insights that are simple and easily viable precautions (such as the universal use of surgical masks both for patients and health care professionals during wound care, the widespread diffusion of hand sanitizers, and the reduction of the number of visitors in the surgical wards) could be promising and safe tools for SSI risk reduction.
本研究旨在评估 COVID-19 大流行期间由于严格的卫生规则和限制接触而导致的腹股沟血管暴露术后手术部位感染（SSI）的发生率和严重程度是否受到影响。
自 2020 年 3 月起，实施了严格的卫生措施，以保护医护人员（HCW）和患者免受 COVID-19 感染，并于 2020 年 7 月部分放宽。主要暴露因素是患者接受手术的时期。因此，研究对象分为两组进行后续比较（COVID-19 前时期：2018 年 3 月至 6 月和 2019 年，COVID-19 时期：2020 年 3 月至 6 月）。主要终点是术后 30 天内发生浅表和/或深部 SSI。使用疾病控制和预防中心的定义来分类浅表和深部 SSI。
共回顾性分析了 194 例连续接受腹股沟血管暴露手术的患者。其中，60 例于 2018 年 4 月 1 日至同年 6 月 30 日接受手术；83 例于 2019 年 4 月 1 日至同年 6 月 30 日接受手术；51 例于 2020 年 4 月 1 日至同年 6 月 30 日接受手术。研究队列的平均年龄为 75 岁，140 例（72%）为男性。在 COVID-19 时期接受手术的患者发生 SSI 的可能性较低（10%比 28%；P=0.008），包括深部 SSI（4%比 13%；P=0.04）和浅表 SSI（6%比 15%；P=0.05）。多变量调整后，发现 COVID-19 时期手术是 SSI 发展的负预测因素（比值比[OR]0.31；95%置信区间[CI]0.09-0.76；P<0.001）或深部 SSI（OR 0.21；95%CI 0.03-0.98；P<0.001）。手术时间也被发现是深部 SSI 发展的独立预测因素（OR 1.21；95%CI 1.21-1.52；P=0.02）。使用二项逻辑回归，无法确定浅表 SSI 的独立预测因素。
腹股沟血管暴露术存在不可忽视的 SSI 风险。在本研究中，我们提供了重要的见解，即简单且可行的预防措施（例如在伤口护理期间普遍使用手术口罩、广泛使用手部消毒剂和减少手术病房的访客数量）可能是降低 SSI 风险的有希望且安全的工具。
