2010年北京地区全髋关节置换术手术部位感染目标性监测分析

Targeted monitoring of surgical site infections after total hip arthroplasty in Beijing in 2010

目的通过分析2010年北京地区全髋关节置换术手术部位感染目标性监测数据,探讨全髋关节置换术手术部位感染率及危险因素,并间接评价手术部位感染导致的经济损失。方法该研究数据来自北京医院感染监控管理系统,2010年1-12月对北京地区的39所医院的714例全髋关节置换术进行前瞻性研究,采用SPSS 12.0软件对与手术部位感染相关的危险因素进行单因素以及多因素logistic回归分析,并且采用Mann-Whitney检验比较感染组与未感染组住院日的差异。结果 714例初次全髋关节置换术患者术后SSI发生率为2.24%;多因素logistic回归分析显示,手术医院级别、手术后进入ICU、糖尿病以及手术前住院日是全髋关节置换术手术部位感染发生的危险因素;感染组(中位数31.0d)与未感染组(中位数16.9d)的住院日比较,差异有统计学意义(P<0.05)。结论北京地区全髋关节置换术手术部位感染发生率与欧美国家的类似;手术部位感染所造成的经济损失将越来越受到重视,对SSI进行目标性监测有助于降低医疗体制所承受的巨大经济损失;全髋关节置换术手术部位感染的发生是多因素的综合,必须采取综合性的预防措施才能有效降低其发生率。

OBJECTIVE To explore the surgical site infection rate and the risk factors and estimate the economic loss due to surgical site infections indirectly by analyzing data from targeted monitoring of surgical site infections after total hip arthroplasty in 2010. METHODS A total of 714 patients who underwent total hip replacements from 39 hospitals in Beijing were monitored prospectively by Beijing Nosocomial Infection Surveillance System from Jan 2010 to Dec 2010. Univariate and multivariate logistic analysis of all related risk factors for surgical site infections were analyzed with statistical software SPSS 12.0. At the same time, the total hospital stay between surgical-site- infection group and non-surgical-site-infection group was compared by Mann-Whitney test. RESULTS The incidence of surgical site infection was 2.24% in the 714 patients undergoing the first total hip replacements; the multiple logistic regression analysis showed that the hospital ranking, transfer into ICU after operation, diabetes, and length of preoperative hospital stay were the risk factors for surgical site infections; the difference in the hospital stay between the infection group （ the median 31.0d） and non-infection group（ the median 16.9d） was statistically significant （P〈0. 05）. CONCLUSION The incidence of surgical site infections after total hip replacement in Beijing is similar to that in America and the European countries; the economic losses due to surgical site infections are increasingly emphasized, the targeted surveillance for SSI is helpful to reduce the economical loss endured by heath care system; the surgical site infections after total hip arthroplasty are under the combined effect of multiple factors, it is necessary to take comprehensive prevention measures to reduce its incidence.