Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL.
University of Miami Miller School of Medicine, Miami, FL.
Urol Oncol. 2023 Nov;41(11):455.e17-455.e24. doi: 10.1016/j.urolonc.2023.06.016. Epub 2023 Jul 29.
To investigate clinical risk factors associated with postoperative deep incisional or organ/space surgical site infections (SSI) following radical cystectomy (RC) in a well characterized and large contemporary cohort.
We used the American College of Surgeons National Surgical Quality Improvement Program database to identify adult patients who underwent RC for bladder cancer between 2015 and 2020 (n = 13,081). We conducted multivariable-adjusted logistic regression and Cox adjusted proportional hazards regression analysis to identify clinical predictors of deep incisional or organ/space SSI in the 30-day postoperative-period following RC.
Deep incisional or organ/space SSI risk increased with continent urinary diversion (HR = 1.61, 95% CI: 1.38-1.88; P < 0.001), obesity (HR = 1.60, 95% CI: 1.35-1.90; P < 0.001), diabetes mellitus (HR = 1.30, 95% CI: 1.13-1.51; P < 0.001), and being functionally dependent before surgery (HR = 2.09, 95% CI: 1.44-3.03; P < 0.001).
Postoperative deep incisional or organ/space SSIs following RC occur more frequently in patients who were obese, diabetic, functionally dependent before surgery, and those who underwent continent urinary diversion. These findings may assist urologists in preoperative counseling, medical optimization, and choice of urinary diversion approach, as well as improved patient monitoring and identification of candidates for intervention postoperatively.
在一个特征明确且规模较大的当代队列中，研究与根治性膀胱切除术（RC）后深部切口或器官/间隙手术部位感染（SSI）相关的临床危险因素。
我们使用美国外科医师学院国家外科质量改进计划数据库，确定了 2015 年至 2020 年期间因膀胱癌接受 RC 的成年患者（n=13081）。我们进行了多变量调整后的逻辑回归和 Cox 调整后的比例风险回归分析，以确定 RC 后 30 天内深部切口或器官/间隙 SSI 的临床预测因素。
有创性或器官/间隙 SSI 风险随着可控性尿流改道（HR=1.61，95%CI：1.38-1.88；P<0.001）、肥胖（HR=1.60，95%CI：1.35-1.90；P<0.001）、糖尿病（HR=1.30，95%CI：1.13-1.51；P<0.001）和术前功能依赖（HR=2.09，95%CI：1.44-3.03；P<0.001）而增加。
RC 后深部切口或器官/间隙 SSI 更常发生在肥胖、糖尿病、术前功能依赖以及接受可控性尿流改道的患者中。这些发现可能有助于泌尿科医生进行术前咨询、医学优化和尿流改道方法的选择，以及改进术后患者监测和确定干预候选人。
