Catalyst Consultants, Poole, UK
Catalyst Consultants, Poole, UK.
BMJ Open. 2023 Dec 18;13(12):e076735. doi: 10.1136/bmjopen-2023-076735.
To characterise surgical site infections (SSIs) after open surgery in the UK's National Health Service.
Retrospective cohort analysis of electronic records of patients from Clinical Practice Research Datalink, linked with Hospital Episode Statistics' secondary care datasets.
Clinical practice in the community and secondary care.
Cohort of 50 000 adult patients who underwent open surgery between 2017 and 2022.
Incidence of SSI, clinical outcomes, patterns of care and costs of wound management.
11% (5281/50 000) of patients developed an SSI a mean of 18.4±14.7 days after their surgical procedure, of which 15% (806/5281) were inpatients and 85% (4475/5281) were in the community after hospital discharge. The incidence of SSI varied according to anatomical site of surgery. The incidence also varied according to a patient's risk and whether they underwent an emergency procedure. SSI onset reduced the 6 months healing rate by a mean of 3 percentage points and increased time to wound healing by a mean of 15 days per wound. SSIs were predominantly managed in the community by practice and district nurses and 16% (850/5281) of all patients were readmitted into hospital. The total health service cost of surgical wound management following SSI onset was a mean of £3537 per wound ranging from £2542 for a low-risk patient who underwent an elective procedure to £4855 for a high-risk patient who underwent an emergency procedure.
This study provides important insights into several aspects of SSI management in clinical practice in the UK that have been difficult to ascertain from surveillance data. Surgeons are unlikely to be fully aware of the true incidence of SSI and how they are managed once patients are discharged from hospital. Current SSI surveillance services appear to be under-reporting the actual incidence.
描述英国国民保健系统（NHS）开放性手术后的手术部位感染（SSI）情况。
对来自临床实践研究数据链接（Clinical Practice Research Datalink）的患者电子记录进行回顾性队列分析，并与医院事件统计（Hospital Episode Statistics）的二级护理数据集进行链接。
社区和二级护理中的临床实践。
2017 年至 2022 年间接受开放性手术的 50000 名成年患者的队列。
SSI 的发生率、临床结局、护理模式和伤口管理成本。
11%（5281/50000）的患者在手术 18.4±14.7 天后出现 SSI，其中 15%（806/5281）为住院患者，85%（4475/5281）在出院后为社区患者。SSI 的发生率根据手术部位的解剖位置而有所不同。发生率还根据患者的风险以及是否进行了紧急手术而有所不同。SSI 的发生使 6 个月的愈合率平均降低 3 个百分点，并使每个伤口的愈合时间平均延长 15 天。SSI 主要由实践和地区护士在社区中进行管理，850/5281（16%）的所有患者再次住院。SSI 发生后，手术伤口管理的总医疗服务成本平均为每个伤口 3537 英镑，从低风险患者接受择期手术的 2542 英镑到高风险患者接受紧急手术的 4855 英镑不等。
这项研究提供了有关英国临床实践中 SSI 管理的几个方面的重要见解，这些方面很难从监测数据中确定。外科医生可能不完全了解 SSI 的真实发生率以及患者出院后如何进行管理。目前的 SSI 监测服务似乎报告了实际发生率偏低。
