胃肠道手术后并发术后感染的随时间变化的死亡风险：丹麦对859,766名患者的全国性研究。

Time-varying mortality risk after gastrointestinal surgery complicated by postoperative infections: a Danish Nationwide study of 859,766 patients.

作者信息

Orgun Doruk, Nordestgaard Ask Tybjaerg, Vogelsang Rasmus Peuliche, Poulsen Henrik Enghusen, Ellervik Christina, Gogenur Ismail

机构信息

Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge and Roskilde, Roskilde, Denmark.

Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Lykkebaekvej 1, Køge, 4600, Denmark.

出版信息

Langenbecks Arch Surg. 2025 May 7;410(1):152. doi: 10.1007/s00423-025-03718-4.

DOI:10.1007/s00423-025-03718-4

PMID:40332624

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12058871/

Abstract

PURPOSE

Postoperative infections are associated with increased mortality risk, but it is unclear if this risk increase persists over time. This study aims to estimate mortality risk associated with postoperative infections at different time-points within the first postoperative year in a nationwide cohort of gastrointestinal surgery patients.

METHODS

We included all individuals residing in Denmark who underwent gastrointestinal surgery between 1996 and 2018 and were alive at postoperative day 30. For different time-intervals during the one-year follow-up, we calculated mortality rates and cumulative incidences of death for patients with and without 30-day postoperative infections. Time-varying Cox regression analyses estimated the relative mortality risk associated with postoperative infection exposure.

RESULTS

Of 859,766 patients (female:49.2%; median age:51 years), 25,126 (2.9%) had at least one 30-day postoperative infection. In patients with or without infections, cumulative incidences of death between postoperative days 30-365 were 13.5% versus 4.7%. Adjusted hazard ratios (HRs) for mortality from postoperative days 30, 91, 181, and 271 until end of follow-up (until postoperative day 365) were 2.25(95% CI:2.13-2.38), 1.88(1.74-2.04), 1.44(1.29-1.62), and 1.11(1.00-1.28) for any postoperative infection compared to no infection (p<0.001). The adjusted HRs for mortality for postoperative days 30-365 in patients exposed to different postoperative infection types were: sepsis: 4.38(3.90-4.93), pneumonia: 2.60(2.37-2.85), urinary tract infection: 1.26(1.05-1.52), surgical site infection: 1.16(1.04-1.30).

CONCLUSION

Compared to patients with no infection, patients exposed to 30-day postoperative infections after gastrointestinal surgery had a 2.3-fold risk of mortality at postoperative days 30, and the relative risk of mortality attributed to infection exposure gradually diminished over time.

摘要

目的

术后感染与死亡风险增加相关，但尚不清楚这种风险增加是否会随时间持续存在。本研究旨在估计在全国范围内的胃肠道手术患者队列中，术后第一年内不同时间点术后感染相关的死亡风险。

方法

我们纳入了1996年至2018年间在丹麦接受胃肠道手术且术后第30天仍存活的所有个体。对于一年随访期间的不同时间间隔，我们计算了有和没有术后30天感染的患者的死亡率和累积死亡发生率。时变Cox回归分析估计了与术后感染暴露相关的相对死亡风险。

结果

在859,766例患者中（女性：49.2%；中位年龄：51岁），25,126例（2.9%）至少有一次术后30天感染。在有或没有感染的患者中，术后30 - 365天的累积死亡发生率分别为13.5%和4.7%。与未感染相比，术后第30天、91天、181天和271天直至随访结束（直至术后第365天）因任何术后感染导致死亡的调整后风险比（HR）分别为2.25（95%CI：2.13 - 2.38）、1.88（1.74 - 2.04）、1.44（1.29 - 1.62）和1.11（1.00 - 1.28）（p<0.001）。暴露于不同术后感染类型的患者术后30 - 365天死亡的调整后HR分别为：脓毒症：4.38（3.90 - 4.93），肺炎：2.60（2.37 - 2.85），尿路感染：1.26（1.05 - 1.52），手术部位感染：1.16（1.04 - 1.30）。