EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
Infect Control Hosp Epidemiol. 2023 Oct;44(10):1601-1606. doi: 10.1017/ice.2023.40. Epub 2023 Mar 22.
The incidence of surgical site infection (SSI) is highest after colorectal surgery. We assessed the impact of risk factors for SSI using the population attributable fraction (PAF).
Retrospective cohort study.
Portuguese hospitals performing regular surveillance.
We identified patients who underwent colorectal procedures in hospitals that reported colorectal surgeries every year between 2015 and 2019. Among 42 reporting hospitals, 18 hospitals were included.
Risk-factor incidence was estimated using the National Epidemiological Surveillance platform from 2015 to 2019. This platform follows the methodology recommended by the European Centre for Disease Prevention and Control. American Society of Anaesthesiologists (ASA) physical classification, wound classification, open surgery, urgent operation, antibiotic prophylaxis, operation time, and male sex were included as risk factors. Measures of association were retrieved from published meta-analyses. PAFs were calculated using the Levin formula. To account for interaction between risk factors, communality of risk factors was used in a weighted-sum approach, providing a combined value that serves as a measure of the comprehensiveness of surveillance.
Among 11,219 reported procedures, the cumulative SSI incidence was 16.8%. The proportion of SSI attributed to all risk factors was 61%. Modifiable variables accounted for 31% of procedures; the highest was laparotomy (16.8%), and urgent operations (2.7%) had the lowest value. Nonmodifiable factors accounted for 28.7%; the highest was wound classification (14.3%).
A relevant proportion (39%) of SSI remains unaccounted for by current surveillance. Almost one-third of SSI cases have potentially modifiable factors. Interventions focusing on shorter, less invasive procedures may be optimally effective in reducing the SSI incidence.
结直肠手术后手术部位感染（SSI）的发生率最高。我们使用人群归因分数（PAF）评估 SSI 的危险因素的影响。
回顾性队列研究。
进行常规监测的葡萄牙医院。
我们确定了在 2015 年至 2019 年间每年报告结直肠手术的医院中接受结直肠手术的患者。在 42 家报告医院中，有 18 家医院被纳入研究。
使用 2015 年至 2019 年国家流行病学监测平台估计危险因素的发生率。该平台遵循欧洲疾病预防控制中心推荐的方法。美国麻醉医师协会（ASA）体格分类、伤口分类、开放性手术、紧急手术、抗生素预防、手术时间和男性等被认为是危险因素。关联的度量从已发表的荟萃分析中获取。使用莱文公式计算 PAF。为了考虑危险因素之间的相互作用，使用危险因素的共性进行加权和方法，提供一个综合值，作为监测全面性的衡量标准。
在报告的 11219 例手术中，累积 SSI 发生率为 16.8%。所有危险因素归因于 SSI 的比例为 61%。可修改的变量占手术的 31%；其中最高的是剖腹手术（16.8%），而紧急手术（2.7%）的比例最低。不可修改的因素占 28.7%；其中最高的是伤口分类（14.3%）。
目前的监测方法仍有 39%的 SSI 无法解释。近三分之一的 SSI 病例存在潜在的可修改因素。关注更短、创伤更小的手术的干预措施可能是降低 SSI 发生率的最佳有效措施。
