Yamamoto Takehito, Yoshitomi Mami, Oshimo Yoshiki, Nishikawa Yuta, Hisano Koji, Nakano Kenzo, Kawai Takayuki, Okuchi Yoshihisa, Iguchi Kohta, Tanaka Eiji, Fukuda Meiki, Taura Kojiro, Terajima Hiroaki
Department of Gastroenterological Surgery and Oncology, Medical Research Institute KITANO HOSPITAL, Osaka, Japan.
Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
Front Surg. 2023 Apr 12;10:1150460. doi: 10.3389/fsurg.2023.1150460. eCollection 2023.
Surgical site infection (SSI) is one of the most important complications of surgery for gastroenterological malignancies because it leads to a prolonged postoperative hospital stay and increased inpatient costs. Furthermore, SSI can delay the initiation of postoperative treatments, including adjuvant chemotherapy, negatively affecting patient prognosis. Identifying the risk factors for SSI is important to improving intra- and postoperative wound management for at-risk patients.
Patients with gastroenterological malignancies who underwent surgery at our institution were retrospectively reviewed and categorized according to the presence or absence of incisional SSI. Clinicopathological characteristics such as age, sex, body mass index, malignancy location, postoperative blood examination results, operation time, and blood loss volume were compared between groups. The same analysis was repeated of only patients with colorectal malignancies.
A total of 528 patients (330 men, 198 women; mean age, 68 ± 11 years at surgery) were enrolled. The number of patients with diseases of the esophagus, stomach, small intestine, colon and rectum, liver, gallbladder, and pancreas were 25, 150, seven, 255, 51, five, and 35, respectively. Open surgery was performed in 303 patients vs. laparoscopic surgery in 225 patients. An incisional SSI occurred in 46 patients (8.7%). Multivariate logistic regression analysis showed that postoperative hyperglycemia (serum glucose level ≥140 mg/dl within 24 h after surgery), colorectal malignancy, and open surgery were independent risk factors for incisional SSI. In a subgroup analysis of patients with colorectal malignancy, incisional SSI occurred in 27 (11%) patients. Open surgery was significantly correlated with the occurrence of incisional SSI ( = 0.024).
Postoperative hyperglycemia and open surgery were significant risk factors for SSI in patients with gastroenterological malignancies. Minimally invasive surgery could reduce the occurrence of incisional SSI.
手术部位感染（SSI）是胃肠恶性肿瘤手术最重要的并发症之一，因为它会导致术后住院时间延长和住院费用增加。此外，SSI会延迟术后治疗的开始，包括辅助化疗，对患者预后产生负面影响。识别SSI的风险因素对于改善高危患者的术中和术后伤口管理非常重要。
对在我院接受手术的胃肠恶性肿瘤患者进行回顾性研究，并根据是否发生切口SSI进行分类。比较两组患者的临床病理特征，如年龄、性别、体重指数、恶性肿瘤位置、术后血液检查结果、手术时间和失血量。仅对结直肠癌患者重复进行相同分析。
共纳入528例患者（男性330例，女性198例；手术时平均年龄68±11岁）。食管癌、胃癌、小肠癌、结肠直肠癌、肝癌、胆囊癌和胰腺癌患者的数量分别为25例、150例、7例、255例、51例、5例和35例。303例患者接受开放手术，225例患者接受腹腔镜手术。46例患者（8.7%）发生切口SSI。多因素logistic回归分析显示，术后高血糖（术后24小时内血清葡萄糖水平≥140mg/dl）、结直肠癌和开放手术是切口SSI的独立危险因素。在结直肠癌患者的亚组分析中，27例（11%）患者发生切口SSI。开放手术与切口SSI的发生显著相关（P = 0.024）。
术后高血糖和开放手术是胃肠恶性肿瘤患者发生SSI的重要危险因素。微创手术可减少切口SSI的发生。
