Reichert Martin, Eckerth Lukas, Fritzenwanker Moritz, Imirzalioglu Can, Amati Anca-Laura, Askevold Ingolf, Padberg Winfried, Hecker Andreas, Liese Juliane, Bender Fabienne
Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35390 Giessen, Germany.
German Center for Infection Research (DZIF), Site Giessen-Marburg-Langen, Justus-Liebig-University of Giessen, Schubertstrasse 81, 35392 Giessen, Germany.
J Clin Med. 2023 Aug 10;12(16):5219. doi: 10.3390/jcm12165219.
Antibiotic therapy following surgical perianal abscess drainage is debated, but may be necessary for high-risk patients. Frailty has been shown to increase the risk of unfavorable outcomes in elderly surgical patients. This study aims to identify high-risk patients by retrospectively analyzing a single-center cohort and using a pretherapeutic score to predict the need for postoperative antibiotics and extended nursing care following perianal abscess drainage surgery. The perianal sepsis risk score was developed through univariable and multivariable analysis. Internal validation was assessed using the area under receiver-operating characteristic curve. Elderly, especially frail patients exhibited more severe perianal disease, higher frequency of antibiotic therapy, longer hospitalization, poorer clinical outcomes. Multivariable analysis revealed that scores in the 5-item modified frailty index, severity of local infection, and preoperative laboratory markers of infection independently predicted the need for prolonged hospitalization and anti-infective therapy after abscess drainage surgery. These factors were combined into the perianal sepsis risk score, which demonstrated better predictive accuracy for prolonged hospitalization and antibiotic therapy compared with chronological age or frailty status alone. Geriatric assessments are becoming increasingly important in clinical practice. The perianal sepsis risk score identifies high-risk patients before surgery, enabling early initiation of antibiotic therapy and allocation of additional nursing resources.
肛周脓肿切开引流术后的抗生素治疗存在争议，但对于高危患者可能是必要的。衰弱已被证明会增加老年外科患者出现不良结局的风险。本研究旨在通过回顾性分析单中心队列，并使用治疗前评分来预测肛周脓肿引流术后患者对术后抗生素及延长护理的需求，从而识别高危患者。通过单变量和多变量分析得出肛周脓毒症风险评分。使用受试者操作特征曲线下面积进行内部验证。老年患者，尤其是衰弱患者表现出更严重的肛周疾病、更高的抗生素治疗频率、更长的住院时间以及更差的临床结局。多变量分析显示，5项改良衰弱指数评分、局部感染严重程度以及术前感染实验室指标可独立预测脓肿引流术后延长住院时间和抗感染治疗的需求。将这些因素合并为肛周脓毒症风险评分，与仅按实际年龄或衰弱状态相比，该评分对延长住院时间和抗生素治疗具有更好的预测准确性。老年评估在临床实践中变得越来越重要。肛周脓毒症风险评分可在手术前识别高危患者，从而能够早期开始抗生素治疗并分配额外的护理资源。
