北京市乳腺癌根治术后手术部位感染危险因素:一项多中心前瞻性监测结果

Risk factors for surgical site infection after radical mastectomy for breast cancer in Beijing City:a multi-center prospective surveillance

目的调查北京地区乳腺癌根治手术后手术部位感染(SSI)发病率及其危险因素。方法通过北京医院感染监控管理系统,对全市83所二级及以上医疗机构进行乳腺癌根治/改良根治术前瞻性监测,应用SPSS 20.0软件对SSI情况进行描述分析及logistic回归分析。结果共纳入2012—2017年监测数据库中8248例病例,发生SSI 62例,发病率为0.75%。糖尿病、手术后入住过ICU、手术时长和ASA评分是乳腺癌根治/改良根治术患者SSI的危险因素。糖尿病患者相较于非糖尿病患者SSI的风险增加(OR=2.99,95%CI:1.33~6.73);术后入住过ICU的患者发生SSI的风险是未入住过ICU的5.72倍(OR=5.72,95%CI:1.68~19.45);手术时间每增加1 h,术后感染的风险增加27%(OR=1.27,95%CI:1.11~1.46);ASA评分每高一个级别,SSI的风险将增加54%(OR=1.54,95%CI:1.01~2.35)。结论多中心大样本的目标监测提示2012—2017年北京地区乳腺癌手术后SSI发病率较低。糖尿病、入住过ICU、手术时间和ASA评分应作为预判SSI的重要因素,在综合考虑影响患者SSI的因素后制定个性化预防策略。

Objective To investigate incidence and risk factors of surgical site infection(SSI)after radical mastectomy for breast cancer in Beijing City.Methods Trough the infection surveillance and management system of hospitals in Beijing,prospective surveillance on radical mastectomy/modified radical mastectomy for breast cancer were performed in 83 secondary and above medical institutions in the whole city,descriptive analysis and logistic regression analysis was conducted by SPSS 20.0 software.Results A total of 8248 cases of SSI in surveillance database from 2012 to 2017 were included in analysis,62 cases of SSI occurred,incidence was 0.75%.Diabetes,post-operative stay in ICU,length of operation and ASA score were risk factors for SSI in patients undergoing radical mastectomy/modified radical mastectomy for breast cancer.Diabetes patients had an increased risk of SSI compared with non-diabetic patients(OR=2.99,95%CI:1.33-6.73);risk of SSI in patients who had stayed in ICU was 5.72 times higher than that in patients who didn’t stay in ICU(OR=5.72,95%CI:1.68-19.45);risk of post-operative infection increased by 27%for each additional 1 hour of operation time(OR=1.27,95%CI:1.11-1.46);risk of SSI increased by 54%for each higher ASA score(OR=1.54,95%CI:1.01-2.35).Conclusion The multi-center large sample surveillance indicates that the incidence of SSI after mastectomy for breast cancer is lower in Beijing from 2012 to 2017.Diabetes,stay in ICU,duration of operation and ASA score should be taken as an important factor for predicting SSI,after considering factors affecting wound infection,a personalized preventive stra-tegy should be formulated.