Dexter Franklin, Epstein Richard H, Loftus Randy W
Anesthesia, University of Iowa, Iowa City, USA.
Anesthesiology, University of Miami Miller School of Medicine, Miami, USA.
Cureus. 2023 Mar 29;15(3):e36878. doi: 10.7759/cureus.36878. eCollection 2023 Mar.
Background Earlier studies have shown that prevention of surgical site infection can achieve net cost savings when targeted to operating rooms with the most surgical site infections. Methodology This retrospective cohort study included all 231,057 anesthetics between May 2017 and June 2022 at a large teaching hospital. The anesthetics were administered in operating rooms, procedure rooms, radiology, and other sites. The 8,941 postoperative infections were identified from International Classification of Diseases diagnosis codes relevant to surgical site infections documented during all follow-up encounters over 90 days postoperatively. To quantify the inequality in the counts of infections among anesthetizing locations, the Gini index was used, with the Gini index being proportional to the sum of the absolute pairwise differences among anesthetizing locations in the counts of infections. Results The Gini index for infections among the 112 anesthetizing locations at the hospital was 0.64 (99% confidence interval = 0.56 to 0.71). The value of 0.64 is so large that, for comparison, it exceeds nearly all countries' Gini index for income inequality. The 50% of locations with the fewest infections accounted for 5% of infections. The 10% of locations with the most infections accounted for 40% of infections and 15% of anesthetics. Among the 57 operating room locations, there was no association between counts of cases and infections (Spearman correlation coefficient r = 0.01). Among the non-operating room locations (e.g., interventional radiology), there was a significant association (Spearman r = 0.79). Conclusions Targeting specific anesthetizing locations is important for the multiple interventions to reduce surgical site infections that represent fixed costs irrespective of the number of patients (e.g., specialized ventilatory systems and nightly ultraviolet-C disinfection).
背景 早期研究表明，针对手术部位感染发生率最高的手术室采取预防措施，可实现净成本节约。方法 这项回顾性队列研究纳入了2017年5月至2022年6月期间在一家大型教学医院进行的所有231,057例麻醉病例。这些麻醉操作在手术室、诊疗室、放射科及其他场所进行。通过国际疾病分类诊断编码，从术后90天内所有随访记录中确定了8941例与手术部位感染相关的术后感染病例。为了量化不同麻醉地点感染病例数的不平等程度，采用了基尼指数，该指数与各麻醉地点感染病例数的绝对两两差异之和成正比。结果 该医院112个麻醉地点的感染基尼指数为0.64（99%置信区间 = 0.56至0.71）。0.64这个数值非常大，相比之下，几乎超过了所有国家的收入不平等基尼指数。感染病例数最少的50%的地点，其感染病例占总数的5%。感染病例数最多的10%的地点，其感染病例占总数的40%，麻醉病例占总数的15%。在57个手术室地点中，病例数与感染数之间无关联（斯皮尔曼相关系数r = 0.01）。在非手术室地点（如介入放射科），两者存在显著关联（斯皮尔曼r = 0.79）。结论 针对特定的麻醉地点进行多种干预措施对于减少手术部位感染很重要，这些干预措施代表固定成本，与患者数量无关（例如，专用通气系统和夜间紫外线C消毒）。
