Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
Department of Urology, St. James's Hospital, Dublin 8, Ireland.
World J Surg. 2023 Oct;47(10):2310-2318. doi: 10.1007/s00268-023-07112-3. Epub 2023 Jul 24.
A reduction in surgical site infections (SSIs) has been reported in several discrete patient populations during the COVID-19 pandemic. Herein, this study evaluates the impact of the COVID-19 pandemic on SSI in a large patient cohort incorporating multiple surgical disciplines. We hypothesize that enhanced infection control and heightened awareness of such measures is analogous to an SSI care bundle, the hypothetical "COVID bundle", and may impact SSI rates.
Data collected for the American College of Surgeons National Surgical Quality Improvement Program between January 1, 2015, and April 1, 2021, were retrospectively analyzed. SSI rates were compared among time-dependent patient cohorts: Cohort A (pre-pandemic, N = 24,060, 87%) and Cohort B (pandemic, N = 3698, 13%). Time series and multivariable analyses predicted pre-pandemic and pandemic SSI trends and tested for association with timing of surgery.
The overall SSI incidence was reduced in Cohort B versus Cohort A (2.8% vs. 4.5%, p < 0.001). Multivariable analysis indicated a downward SSI trend before pandemic onset (IRR 0.997, 95% CI 0.994, 1). At pandemic onset, the trend reduced by a relative factor of 39% (IRR 0.601, 95% CI 0.338, 1.069). SSI then trended upward during the pandemic (IRR 1.035, 95% CI 0.965, 1.111). SSI rates significantly trended downward in general surgical patients at pandemic onset (IRR 0.572, 95% CI 0.353, 0.928).
Although overall SSI incidence was reduced during the pandemic, a statistically significant decrease in the predicted SSI rate only occurred in general surgical patients at pandemic onset. This trend may suggest a positive impact of the "COVID bundle" on SSI rates in these patients.
在 COVID-19 大流行期间，已在多个特定患者群体中报告了手术部位感染 (SSI) 的减少。在此，本研究评估了 COVID-19 大流行对纳入多个外科专业的大量患者队列中 SSI 的影响。我们假设，增强感染控制和提高对这些措施的认识类似于 SSI 护理包，即假设的“COVID 包”，并可能影响 SSI 发生率。
回顾性分析了 2015 年 1 月 1 日至 2021 年 4 月 1 日期间美国外科医师学院国家外科质量改进计划收集的数据。在时间依赖性患者队列中比较了 SSI 发生率：队列 A（大流行前，N=24060，87%）和队列 B（大流行期间，N=3698，13%）。时间序列和多变量分析预测了大流行前和大流行期间的 SSI 趋势，并检验了与手术时间的相关性。
与队列 A 相比，队列 B 的总体 SSI 发生率降低（2.8%比 4.5%，p<0.001）。多变量分析表明，在大流行前发病前 SSI 呈下降趋势（IRR 0.997，95%CI 0.994，1）。在大流行开始时，该趋势的相对因子减少了 39%（IRR 0.601，95%CI 0.338，1.069）。此后，大流行期间 SSI 呈上升趋势（IRR 1.035，95%CI 0.965，1.111）。大流行开始时，普通外科患者的 SSI 率显著下降（IRR 0.572，95%CI 0.353，0.928）。
尽管大流行期间整体 SSI 发生率降低，但仅在大流行开始时普通外科患者的预测 SSI 率才出现统计学显著下降。这种趋势可能表明“COVID 包”对这些患者 SSI 率的积极影响。
