Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
Department of Pharmacy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
Sci Rep. 2024 Oct 14;14(1):24055. doi: 10.1038/s41598-024-74389-2.
This retrospective observational study aimed to evaluate the incidence of surgical site infection (SSI) in the era of enhanced recovery after surgery (ERAS) and the effect of ERAS on postoperative outcomes. Totally 1,276 patients (565 in ERAS group and 711 in non-ERAS group) who underwent operations at the department of general surgery during 2017-2021 were included. Risk factors were identified via logistic regression analysis and meta-analysis of all relevant published studies was performed. Subsequently, propensity score matching was used to match different risk factors. Overall, 40 patients were diagnosed with SSI, and the pooled incidence of SSI was 3.13%. In total, 14 (2.48%) and 26 (3.66%) patients in the ERAS and non-ERAS groups, respectively, were diagnosed with SSI (P = 0.230). Among patients for whom the ERAS protocol was adopted, 7 independent risk factors of SSI were identified. After propensity score matching, in patients without SSI, the number of hospital days was significantly lower in the ERAS group than in the non-ERAS group (2 [2, 5] vs. 3 [2, 7], P = 0.005), whereas in patients with SSI, the number of hospital days was similar between the ERAS and non-ERAS groups. ERAS had no effect on the incidence of SSI but could significantly accelerate the discharge of uninfected patients. In the era of ERAS, SSI incidence was affected by the type of surgery; number of postoperative hospital days; type of incision; serum hemoglobin, total protein, and albumin levels; and antibiotic prophylaxis. Furthermore, these results will significantly affect the implementation of the ERAS protocol and optimal preoperative management.
本回顾性观察研究旨在评估加速康复外科（ERAS）时代手术部位感染（SSI）的发生率，以及 ERAS 对术后结局的影响。共纳入 2017 年至 2021 年期间在普通外科接受手术的 1276 例患者（ERAS 组 565 例，非 ERAS 组 711 例）。通过 logistic 回归分析确定危险因素，并对所有相关发表研究进行荟萃分析。随后，采用倾向评分匹配来匹配不同的危险因素。共有 40 例患者被诊断为 SSI，SSI 的总发生率为 3.13%。ERAS 组和非 ERAS 组分别有 14 例（2.48%）和 26 例（3.66%）患者被诊断为 SSI（P=0.230）。在采用 ERAS 方案的患者中，确定了 7 个 SSI 的独立危险因素。经过倾向评分匹配后，在无 SSI 的患者中，ERAS 组的住院天数明显低于非 ERAS 组（2[2,5] vs. 3[2,7]，P=0.005），而在 SSI 患者中，ERAS 组和非 ERAS 组的住院天数相似。ERAS 对 SSI 的发生率没有影响，但可以显著加速未感染患者的出院。在 ERAS 时代，SSI 的发生率受手术类型、术后住院天数、切口类型、血清血红蛋白、总蛋白和白蛋白水平以及抗生素预防等因素的影响。此外，这些结果将对 ERAS 方案的实施和最佳术前管理产生重大影响。
