中国腹部手术后手术部位感染的多中心横断面研究

Surgical site infection after abdominal surgery in China:a multicenter cross-sectional study

目的手术部位感染(SSI)的发生可显著延长术后住院时间,加重患者及社会经济负担,甚至危及患者的生命安全。本研究旨在调查全国范围内腹部手术后SSI的发生率,分析其风险因素,为腹部手术后SSI的防控提供参考依据。方法采用多中心横断面研究方法,收集全国68家医院2020年6月1—30日期间所有接受腹部手术的成年患者的临床资料,包括患者的一般资料、围手术期的相关临床数据以及感染切口微生物培养结果。主要结局指标为腹部手术后30 d内SSI发生率,次要结局变量为重症监护室(ICU)住院时间、术后住院时间、住院费用以及术后30 d病死率。采用多因素Logistic回归模型分析SSI发生的危险因素。结果共纳入5560例腹部手术患者,术后有163例(2.9%)发生SSI,其中器官(腔隙)感染98例(60.1%)、深部切口感染19例(11.7%)、浅部切口感染46例(28.2%)。切口微生物培养结果显示,大肠埃希菌为SSI的主要病原菌(22.7%,37/163)。多因素分析显示,高血压病史(OR=1.792,95%CI:1.194~2.687,P=0.005)、手术部位为小肠(OR=6.911,95%CI:1.846~25.878,P=0.004)、手术时间延长(OR=1.002,95%CI:1.001~1.003,P<0.001)、手术切口等级(污染切口:OR=3.212,95%CI:1.495~6.903,P=0.003;感染切口:OR=11.562,95%CI:3.777~35.391,P<0.001)为SSI发生的危险因素,而行腹腔镜或机器人手术(OR=0.564,95%CI:0.376~0.846,P=0.006)以及术前白蛋白水平每升高1 g/L(OR=0.920,95%CI:0.888~0.952,P<0.001)为SSI发生的保护因素。与非SSI患者相比,SSI患者术后ICU入住率[26.4%(43/163)比9.5%(514/5397),χ2=54.999]和术后30 d病死率[1.84%(3/163)比0.01%(5/5397),χ2=33.642]更高,ICU住院时间(中位数:0比0,U=518414)、术后住院时间(中位数:17 d比7 d,U=656386)和总住院时间(中位数:25 d比12 d,U=648129)均显著延长,住院费用亦明显增加(中位数:7.1万元比3.9万元,U=557966),差异均有统计学意义(均P<0.001)。结论腹部手术后SSI发生率为2.9%。为降低术后SSI的发生,术前应纠正低蛋白血症,选择微创手术,尽量缩短手术时间;在围手术期内对高血压、小肠手术以及切口污染较严重的患者,予以关注并加强护理。

Objective Surgical site infection(SSI)can markedly prolong postoperative hospital stay,aggravate the burden on patients and society,even endanger the life of patients.This study aims to investigate the national incidence of SSI following abdominal surgery and to analyze the related risk factors in order to provide reference for the control and prevention of SSI following abdominal surgery.Methods A multicenter cross-sectional study was conducted.Clinical data of all the adult patients undergoing abdominal surgery in 68 hospitals across the country from June 1 to 30,2020 were collected,including demographic characteristics,clinical parameters during the perioperative period,and the results of microbial culture of infected incisions.The primary outcome was the incidence of SSI within postoperative 30 days,and the secondary outcomes were ICU stay,postoperative hospital stay,cost of hospitalization and the mortality within postoperative 30-day.Multivariable logistic regression was used to analyze risk factors of SSI after abdominal surgery.Results A total of 5560 patients undergoing abdominal surgery were included,and 163 cases(2.9%)developed SSI after surgery,including 98 cases(60.1%)with organ/space infections,19 cases(11.7%)with deep incisional infections,and 46 cases(28.2%)with superficial incisional infections.The results from microbial culture showed that Escherichia coli was the main pathogen of SSI.Multivariate analysis revealed hypertension(OR=1.792,95%CI:1.194-2.687,P=0.005),small intestine as surgical site(OR=6.911,95%CI:1.846-25.878,P=0.004),surgical duration(OR=1.002,95%CI:1.001-1.003,P<0.001),and surgical incision grade(contaminated incision:OR=3.212,95%CI:1.495-6.903,P=0.003;Infection incision:OR=11.562,95%CI:3.777-35.391,P<0.001)were risk factors for SSI,while laparoscopic or robotic surgery(OR=0.564,95%CI:0.376-0.846,P=0.006)and increased preoperative albumin level(OR=0.920,95%CI:0.888-0.952,P<0.001)were protective factors for SSI.In addition,as compared to non-SSI patients,the SSI patients had significantly higher rate of ICU stay[26.4%(43/163)vs.9.5%(514/5397),χ2=54.999,P<0.001]and mortality within postoperative 30-day[1.84%(3/163)vs.0.01%(5/5397),χ2=33.642,P<0.001],longer ICU stay(median:0 vs.0,U=518414,P<0.001),postoperative hospital stay(median:17 days vs.7 days,U=656386,P<0.001),and total duration of hospitalization(median:25 days vs.12 days,U=648129,P<0.001),and higher hospitalization costs(median:71000 yuan vs.39000 yuan,U=557966,P<0.001).Conclusions The incidence of SSI after abdominal surgery is 2.9%.In order to reduce the incidence of postoperative SSI,hypoproteinemia should be corrected before surgery,laparoscopic or robotic surgery should be selected when feasible,and the operating time should be minimized.More attentions should be paid and nursing should be strengthened for those patients with hypertension,small bowel surgery and seriously contaminated incision during the perioperative period.