基于倾向性评分匹配的机器人手术医院感染病例对照研究

A Case-control Study on Nosocomial Infection in Robotic Surgery Based on Propensity Score Matching

目的:分析探讨机器人辅助手术对手术患者医院感染及其危险因素的影响,为掌握机器人手术感染情况及制定相应防控措施提供依据。方法:选取2019年1月1日至2023年6月30日期间湖北省某三甲医院收治的行机器人辅助手术的病例为研究对象,采用1∶4的倾向性评分匹配(PSM)方法对两组患者基线特征进行平衡。多因素logistic回归分析机器人手术患者术后医院感染发生的危险因素。结果:769例机器人手术患者发生医院感染共24例26次,感染率为3.12%,例次感染率3.38%。其中感染部位以下呼吸道为主占29.17%,其次分别是泌尿道占20.83%、上呼吸道、皮肤、腹(盆)腔内组织及手术部位均占8.33%,其他部位占12.5%,感染性腹泻占4.17%。共检出病原菌23株,以革兰氏阴性菌为主占60.87%。多因素logistics回归分析结果显示,手术台次(OR=5.854,95%CI=1.139~30.090,P=0.034)、感染前联用抗生素(OR=5.612,95%CI=1.123~28.036,P=0.036)是机器人手术医院感染的独立危险因素。结论:机器人手术患者术后医院感染发生率较低,应对相关的危险因素采取有效的防控措施,降低医院感染风险。

Objective To analyze the impact of robotic surgery on nosocomial infection and associated risk factors of the sur⁃gical patients,to provide a basis for understanding the infection of robotic surgery and formulating corresponding prevention and control measures.Methods Patients who underwent robotic surgery at a tertiary hospital in Hubei Province between January 1,2019 and June 30,2023,were selected as the research subjects.The 1:4 propensity score matching(PSM)method was used to balance the baseline characteristics of the two groups of patients.Multivariate logistic regression was conducted to identify the risk factors for postoperative nosocomial infections in patients undergoing robotic surgery.Results Among the 769 patients who underwent robotic surgery,24 cases and 26 episodes of nosocomial infections were identified,resulting in an infection rate of 3.12%and an episode infection rate of 3.38%.The primary sites of infection were the lower respiratory tract(29.17%),followed by the urinary tract(20.83%),the upper respiratory tract,skin,tissue in the ab⁃dominal or pelvic cavity,and surgical sites(8.33%each),as well as other areas(12.5%),and infectious diarrhea(4.17%).A total of 23 strains of pathogenic bacteria were detected,with Gram-negative bacteria being the predominant type(60.87%).Multivariate logistic regression revealed that the number of operations(OR=5.854,95%CI=1.139~30.090,P=0.034)and the use of antibiotics before infection(OR=5.612,95%CI=1.123~28.036,P=0036)were independent risk factors for nosocomial infection in robotic surgery.Conclusion The incidence of postoperative nosocomial infections in patients undergoing robotic surgery in the hospital is relatively low,and effective prevention and control measures should be implemented to reduce the risk of the infections.