中老年胃癌手术器官/腔隙感染危险因素及直接经济负担

Risk factors for organ/space infection in middle-age and elderly patients undergoing gastric cancer surgery and direct economic burden

目的探究中老年胃癌手术患者器官/腔隙感染的危险因素和直接经济负担情况。方法对山东省某三级甲等医院2018年1月1日-12月31日收治的492例中老年胃癌手术患者临床资料进行回顾性分析,采用单因素和多因素Logistic回归分析发生器官/腔隙感染的危险因素,并对感染组和非感染组患者进行1:1倾向评分匹配,进行直接经济负担分析。结果纳入研究的492例中老年胃癌手术患者,器官/腔隙感染率为4.07%(20例)。多因素Logistic回归分析结果显示:腹腔引流天数、术后并发症及术中腹腔化疗是中老年胃癌手术患者发生器官/腔隙感染的独立危险因素,而术前30min预防性应用抗菌药物是其保护因素(P<0.05)。发生器官/腔隙感染后直接经济负担达30089.14元,延长住院天数12d。单项医疗费用支出西药费差值最大,为12510.86元。结论器官/腔隙感染会增加中老年胃癌手术患者的经济负担并延长住院时间。临床医务人员应针对器官/腔隙感染的危险因素早期识别感染高危患者,积极开展感染防控工作。

OBJECTIVE To explore the risk factors for organ/space infection in middle-aged and elderly patients undergoing gastric cancer surgery and analyze the direct economic burden.METHODS The clinical data of 492middle-age and elderly patients who received gastric cancer surgery in a tertiary three A hospital of Shandong Province from Jan 1,2018to Dec 31,2018were retrospectively analyzed.Univariate analysis and multivariate logistic regression analysis were performed for risk factors for the organ/space infection,a 1:1propensity score matching was carried out for the patients in the infection group and the non-infection group,and the direct economic burden was analyzed.RESULTS Among the 492patients included in the study,the incidence of organ/space infection was 4.07%(20case).The result of multivariate logistic regression analysis showed that the duration of peritoneal drainage,postoperative complications and intraoperative abdominal chemotherapy were the independent risk factors for the organ/space infection,while the prophylactic use of antibiotics 30minutes before the surgery was a protective factor(P<0.05).The direct economic burden due to the organ/space infection was as much as 30089.14yuan,and the length of hospital stay was extended by 12days.The difference of western medicine cost was the largest with 12510.86yuan among all single medical expenses.CONCLUSION The organ/space infection may increase the economic burden and prolong the length of hospital stay of the middle-aged and elderly patients undergoing gastric cancer surgery.It is necessary for clinicians to identify the patients at high risk of infection in early stage according to the risk factors for the organ/space infection and actively take prevention and control measures.