Incidences and Risk Factors for Surgical Site Infections in Koutiala, Mali

Purpose: This paper aims to assess the incidences and risk factors for surgical site (ISO) infections in the general surgery department of the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study from August 1, 2017 to October 31, 2020 involving all patients who underwent laparotomy in the general surgery department of the Koutiala District Hospital. Patients who were not operated on and who did not have a laparotomy were not included. Age, sex, frequency, patient history, National Nosocomial Infections Surveillance (NNIS) index, time to occur, bacteriological test results and course of infection were analyzed. Results: Fifty patients were registered. The average age was 34.2 ± 21.2 years old. Eleven patients were 60 years old or older. The hospital incidence rate was 4.3% and the community incidence rate was 6.1 cases per 100,000 population. The concept of smoking was noted in 15 patients. Patients were operated on in emergency 84% of cases. Peritonitis was the most common initial lesion with 32% of cases. Our patients had an NNIS index greater than 0 in 84% of cases. The time to develop infection from the surgical site was less than 3 days in 8 patients (16% of cases). Depending on the depth of the infection, it was superficial (cutaneous) in 39 patients (78%) and deep (subcutaneous and organic) in 11 patients (22%). Escherichia coli was the most common germ with 72% followed by staphylococcus aureus at 24%. We noted 22% morbidity. The median length of hospitalization was 9 ± 2.2 days. Conclusion: ISO is common in our service. Prevention and mastery require knowledge of risk factors.

Identification of risk factors for surgical site infection after type Ⅱ and type Ⅲ tibial pilon fracture surgery

BACKGROUND High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation.Infection can negatively impact patient outcomes.AIM To compare risk factors for postoperative infection after open reduction and internal fixation for a pilon fracture.METHODS Among the 137 patients included,67 developed a surgical site infection.Demographic,clinical,and surgical factors were compared between the two groups.A binary logistic regression analysis was used to determine the odds ratio(OR)and corresponding 95% CI for significant risk factors for postoperative infection.RESULTS The distribution of pathogenic bacteria among the 67 patients who developed a surgical site infection was as follows:Gram-positive,58.2%(n=39);Gramnegative,38.8%(n=26);and fungal,2.9%(n=2).The following factors were associated with postoperative infection(P<0.05):a Ruedi–Allgower pilon fracture type Ⅲ(OR=2.034;95%CI:1.109–3.738);a type Ⅲ surgical incision(OR=1.840;95%CI:1.177–2.877);wound contamination(OR=2.280;95%CI:1.378–3.772);and diabetes as a comorbidity(OR=3.196;95%CI:1.209–8.450).CONCLUSION Infection prevention for patients with a Ruedi–Allgower fracture type Ⅲ,surgical incision type Ⅲ,wound contamination,and diabetes lowers the postoperative infection risk after surgical management of tibial pilon fractures.

Risk factors and prediction model for inpatient surgical site infection after elective abdominal surgery

BACKGROUND Surgical site infections(SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors.AIM To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively.METHODS We retrospectively analysed the inpatient records of Shaanxi Provincial People’s Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002(NRS 2002)scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance(NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model.RESULTS A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus(42.2%), the liver(27.6%), the gastrointestinal tract(19.1%), the appendix(5.9%), the kidney(3.7%), and the groin area(1.4%). SSI occurred in 5% of the patients(n = 150). The risk factors associated with SSI were as follows: Age;gender;marital status;place of residence;history of diabetes;surgical season;surgical site;NRS 2002 score;preoperative white blood cell, procalcitonin(PCT), albumin, and low-density lipoprotein cholesterol(LDL) levels;preoperative antibiotic use;anaesthesia method;incision grade;NNIS score;intraoperative blood loss;intraoperative drainage tube placement;surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio(OR) = 5.698, 95% confidence interval(CI): 3.305-9.825, P = 0.001], antibiotic use(OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3(OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia(OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2(OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L(OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L(OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL(OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season(P < 0.05), surgical site(P < 0.05), and incision grade I or Ⅲ(P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score(0.662).CONCLUSION The patient’s condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.

Surgical Site Infection (SSI) in the National Referral General Hospital of Ndjamena (Chad): Survey about Risk Factors

The risk to develop an infection after surgery depends on several factors. Those factors may be interdependent or not, depending on the nature of the surgery and the general condition of the patient. The aim of the present study was to identify the factors involved in the occurrence of the Surgical Site Infections (SSI) in the National referral general hospital of N’djamena (Chad). We first realized an interview in the emergency services and in the general surgery of the hospital. The information collected allowed us to draw up survey sheets. An investigation was then conducted on 152 patients who had surgery and were hospitalized during the study period. The frequency of the SSI was 33.6% (51/152). The main risk factors that we identified were the duration of hospitalization, the category of the hospitalization room, the urgent aspect of the surgical intervention, the patient’s nutritional status and the associated diseases with diabetes, which was present in 52.38% (11/21) of cases of associated pathologies. Analysis of the antibiotic prophylaxis administered to patients showed that ciprofloxacin was more effective in SSI prevention. Indeed, this antibiotic showed the fewest cases of infection with only 1.9% of patients having developed SSI. Our results show a very high frequency of SSI at the National referral general hospital of N’djamena. Poor hospital practices and factors associated to patients seem to be the most factors implicated in the SSI.

Subcutaneous fat thickness and abdominal depth are risk factors for surgical site infection after gastric cancer surgery

BACKGROUND Surgical site infection(SSI)is one of the most common complications after gastric cancer(GC)surgery.The occurrence of SSI can lead to a prolonged postoperative hospital stay and increased medical expenses,and it can also affect postoperative rehabilitation and the quality of life of patients.Subcutaneous fat thickness(SFT)and abdominal depth(AD)can be used as predictors of SSI in patients undergoing radical resection of GC.AIM To explore the potential relationship between SFT or AD and SSI in patients undergoing elective radical resection of GC.METHODS Demographic,clinical,and pre-and intraoperative information of 355 patients who had undergone elective radical resection of GC were retrospectively collected from hospital electronic medical records.Univariate analysis was performed to screen out the significant parameters,which were subsequently analyzed using binary logistic regression and receiver-operating characteristic curve analysis.RESULTS The prevalence of SSI was 11.27%(40/355).Multivariate analyses revealed that SFT[odds ratio(OR)=1.150;95%confidence interval(95%CI):1.090-1.214;P<0.001],AD(OR=1.024;95%CI:1.009-1.040;P=0.002),laparoscopic-assisted surgery(OR=0.286;95%CI:0.030-0.797;P=0.017),and operation time(OR=1.008;95%CI:1.001-1.015;P=0.030)were independently associated with the incidence of SSI after elective radical resection of GC.In addition,the product of SFT and AD was a better potential predictor of SSI in these patients than either SFT or AD alone.CONCLUSION SFT and AD are independent risk factors and can be used as predictors of SSI in patients undergoing radical resection of GC.

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

Nowadays there have been various advanced techniques to overcome disparate types of lumbar degenerative diseases. However, post-operation complications such as Surgical Site Infection (SSI) still give the surgeon with a big challenge. This article is going to study the risk factor that causes the lumbar SSI by reviewing all the articles that can be assessed through PubMed, websites of science and other internet data base. Numerous articles have stated different reported prevalence rates of 0.7% to 16% for surgical site infection. This article will document the most common and significant risk factors for SSI. At last, we suggest that there should be preoperative patient screening and postoperative internal environment maintenance, this will be the best way to reduce postoperative SSI rate or prevent SSI from happening.

Risk Factors for Surgical Site Infections in Patients Operated at the University Clinic of Traumatology-Orthopedics and Restorative Surgery of the National Hospital and University Center Hubert Koutoukou Maga in Cotonou

Background: Operative site infections (ISO) are typically nosocomial. According to the WHO the incidence of ISO varies from 0.5% to 15% and exceeds 25% in developing countries. They result from the combined action of several factors and represent a concern for public health. To study the contributing factors of surgical site infections in patients operated at the University Clinic of Orthopedic Traumatology of CNHU-HKM of Cotonou. Method: This was an analytical cross-sectional study that involved 35 operated patients and ten nurses. Were included in our study: 1) All patients, without distinction of sex or age, having been operated on in the university clinic of orthopedic traumatology, during the survey period;2) Patients hospitalized for post-operative care during the survey period;3) The nursing staff on duty during our study period. The usual statistical measures were used according to the type of variables: means, standard deviations, percentages. Data analysis first involved calculating percentages for the qualitative variables and means followed by their standard deviations for the quantitative variables. Next, the Pearson Chi-square test was used to test the association between the dependent variable and the independent variables of interest. The significance level is set at p Results: The prevalence of surgical site infections was 28.58%. The main factors contributing to the occurrence of SSIs that were found were the patient’s level of education (p = 0.003) and the reuse of bandages used for dressing (p = 0.004). Other potential factors such as the economic status of the patient, the poor quality of technical dressings, and the preoperative stay were also highlighted. Conclusion: Surgical site infections remain a global concern. Risk factors were found on both the patient and nurse sides. It is urgent to address these various factors to minimize the occurrence of surgical site infections.

Risk Factors for Surgical Site Infection after Hip Arthroplasty: A Multicentric Study

The objective of this study is to answer three main questions: What is the risk of wound infection for patients undergoing hip arthroplasty? What are the main etiologicagents of surgical site infection (SSI)? What are the risk factors most associated with surgical site infection? Method: This was a multicentric, retrospective cohort study which analyzed data collected in five general hospitals in Belo Horizonte, Brazil, between the period of January 2009 and December 2013. The continuous parameters studied were age, length of hospital stay before surgery, duration of surgery, number of professionals at surgery and number of hospital admissions. Categorical variables were surgical wound classification (clean, clean contaminated, contaminated, dirty/infected), American Society of Anesthesiologists (ASA) score (I, II, III, IV, V), type of surgery (elective, emergency), general anesthesia (yes, no), prophylactic antibiotic (yes, no), trauma surgery (yes, no) and Nosocomial Infections Surveillance (NNIS) risk index (IRIC = 0, 1, 2, 3). Results: Estimated SSI risk was 3.2% (95% C.I. = 2.6% to 4.1%) and risk of osteomyelitis was 0.6% (95% C.I. = 0.4% to 1.1%). ASA score > 2, general anesthesia, length of hospital stay before surgery higher than four days, more than two professionals at surgical field and duration of surgery higher than five hours were risk factors for SSI after hip prosthesis (p < 0.05). The final multiple logistic regression analysis indicated that the modified NNIS risk was independently associated with surgical site infection after arthroplasty of hip. Conclusion: Despite the modified NNIS index being a risk factor for SSI, none of its independent variables was statistically significantly in the logistic model (p > 0.100). Each modified NNIS risk category increased the chance of a patient being infected by almost three times, when compared with the previous category (OR = 2.82;p = 0.011).

Risk factors and strategy for surgical incision infection in department of abdominal surgery

Objective To study the risk factors of surgical wound infection among the patients in department of abodominal surgery. Methods The factors on surgical wound infection were investigated by retrospective study. The diagnosis standard was based on Diagnosis Standard of Hospital Infection published by Ministry of Health.

Predicting surgical site infections using a novel nomogram in patients with hepatocelluar carcinoma undergoing hepatectomy

BACKGROUND Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for hepatocellular carcinoma (HCC).AIM To identify the risk factors associated with SSI,and develop a nomogram to predict SSI among patients undergoing hepatectomy.METHODS We retrospectively reviewed the data of patients diagnosed with HCC undergoing hepatectomy at two academic institutions in China,and evaluated the occurrence of SSI.Independent risk factors for SSI were identified using univariate and multivariate analyses.Based on these independent risk factors,a nomogram was established using the data of patients in the first institution,and was validated using data from an external independent cohort from the second institution.RESULTS The nomogram was established using data from 309 patients,whereas the validation cohort used data from 331 patients.The operation duration,serum albumin level,repeat hepatectomy,and ASA score were identified as independent risk factors.The concordance index (C-index) of the nomogram for SSI prediction in the training cohort was 0.86;this nomogram also performed well in the external validation cohort,with a C-index of 0.84.Accordingly,we stratified patients into three groups,with a distinct risk range based on the nomogram prediction,to guide clinical practice.CONCLUSION Our novel nomogram offers good preoperative prediction for SSIs in patients undergoing hepatectomy.

Incidence and Outcomes of Surgical Site Infections after Adult Cardiac Surgery: A Single-Center Experience

Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surgeries in Saudi Arabia. Aims: This study aimed to determine the incidence of SSIs after adult cardiac surgeries that were done in Madinah Cardiac Center, Saudi Arabia. Further, to identify the outcomes and risk factors contributing to death among surgical site infection patients. Methods: This was a 6-year, single-center, retrospective cohort study that included 93 consecutive patients who underwent adult cardiac surgery between August 2016 and August 2022. All adult patients aged 18 years or older who had clinical evidence of postoperative surgical wound infection were included. Preoperative, operative, and postoperative data (early and late) were collected from medical records. Microbiological culture reports and clinical outcomes were also recorded. Results: The study revealed a 9.1% (93/1021) incidence rate of SSIs. Of the 93 patients with SSIs, 60 had superficial incisional infections and 33 had deep infections with incidence rates of 5.9% and 3.2%, respectively. In-hospital mortality due to SSI was recorded in 4 out of 93 patients with an incidence rate of 4.3%. There was a significant association between the in-hospital mortality and the type of SSIs (p = 0.014). All non-survivors had deep SSIs. The type of cardiac surgery also showed a significant association with the in-hospital mortality (p = 0.017). Furthermore, the median duration of antibiotic administration was significantly longer in the non-survivors than in the survivors (72.5 vs 17, respectively, p Conclusions: In conclusion, the incidence of surgical wound infections following cardiac surgery is not low (9.1%);of which 3.2% were deep infections. The in-hospital mortality rate after treatment of SSIs was fortunately low (4.3%), and all non-survivors had deep SSIs. The non- survivors showed a significantly longer duration of antibiotics administration than survivors. Combined CABG and valve procedures showed a higher mortality rate (75%) than the isolated procedures.

Research progress in the targeted monitoring of surgical site infections

Surgical treatment can decrease the pain burden of patients, as well as improve their quality of life and social satisfaction. However, postoperative infection and other complications may harm patients and may even cause surgical failure and death. This review describes the definition, classification, and status of surgical site infection(SSI). In addition, this review provides an analysis of the relevant risk factors that result in SSI, and proposes the corresponding preventative and control measures for each different risk factor.

Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy

Objective: To analyze Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and inves-tigate the relationship between the major risk factors and Clavien-Dindo classification of complications. Methods: The retrospective case-control study was adopted. The clinical data of 200 patients who underwent pancreatico-duodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected. The patients underwent Whipple procedure or pylorus-preserving pancreaticoduodenectomy according to the tumor site. Observation indicators included: (1) postoperative complications using Clavien-Dindo classification;(2) univariate and multivariate analyses: patients' basic information, surgery-related factors, pancreas-related factors;(3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy. The chi-square test was applied to univariate analysis and categorical data. The comparison between groups was done by using independent samples nonparametric test (Kolmogorov-Smirnov Z), and multivariate analysis was done by using Logistic regression model. Results: (1) Postoperative complications: Of 200 patients, 122 underwent Whipple procedure and 78 underwent pylorus-preserving pancreaticoduodenectomy, including 6 cases combined with vascular reconstructions and 1 case with RFA of liver tumors. Ninety-eight patients had postoperative complications, including 41 patients with no less than 2 types of complications. After surgery, pancreatic fistula was detected in 80 patients, including 42 cases with grade A, 28 cases with grade B and 10 cases with grade C;incisional infection in 29 patients;gastric retention in 24 patients;intra-abdominal infection in 16 patients;intra-abdominal hemorrhage in 10 patients, including 8 patients receiving interventional treatment;biliary leakage in 7 patients and unplanned reoperation in 2 patients. Three patients were dead during hospitalization. The incidences of complications in grade Ⅰ, Ⅱ, Ⅲ (Ⅲ a and Ⅲ b), Ⅳ and Ⅴ of Clavien-Dindo classification were 28.00% (56/200), 13.00% (26/200), 5.00% (10/200), 1.50% (3/200) and 1.50% (3/200). (2) Univariate and multivariate analyses: The results of univariate analysis showed that body mass index (BMI) and pancreas texture were risk factors affecting complications after pancreaticoduodenectomy (χ2 = 6.483, Z = -3.189, p < .05). The results of multivariate analysis showed that BMI > 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR = 2.044, 1.649, 95% confidence interval: 1.212-3.447, 1.194-2.275). (3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed. There were statistically significant differences between BMI or pancreas texture and Clavien-Dindo classification of complications after pancreaticoduodenectomy (χ2 = 13.897, 27.077, p < .05). Conclusions: Clavien-Dindo classification of complications after pancreaticoduodenectomy contributes to comprehensive com-parison and evaluation, and this type of classification in this study mainly refers to grade I and II. Reducing BMI and good management of pancreatic stump may improve Clavien-Dindo classification of complications after pancreaticoduodenectomy.

Surgical site infections after elective craniotomy for brain tumor:a study on potential risk factors and related treatments

Background Surgical site infection(SSI)is a common complication following craniotomy that increases morbidity,mortality,and medical expenses.The objectives of this study were to determine the relevant risk factors associated with SSI after elective craniotomy for brain tumor and analyse the treatments for SSI.Methods A retrospective nested case-control study was conducted using data from patients who underwent craniotomy for brain tumor resection at the Neurosurgical Oncology Department No.6 of Beijing Tiantan Hospital,Capital Medical University,between January 2019 and December 2021.Risk factors for SSI were determined using multivariate logistic regression analysis.We analyzed microbiological and related treatment data for different SSI types.Results Among 2061 patients who underwent craniotomy for brain tumor,31 had SSI(1.50%).In the multivariate logistic regression analysis,body mass index(BMI)and operative duration were identified as independent risk factors for SSI.The most common microorganism isolated from SSIs was Staphylococcus epidermidis(22.9%),and drug sensitivity results showed that gram-positive bacteria were sensitive to linezolid,vancomycin and tigecycline,whereas gram-negative bacteria were sensitive to meropenem,cefepime and ceftazidime.Six of the seven patients who underwent bone flap removal due to osteomyelitis were infected with gram-negative bacteria.Conclusions BMI and operative duration were identified as independent risk factors for SSI.Diabetes mellitus,previous ratio therapy,type of incision,recurrence tumor and other risk factors were not found to be associated with the occurrence of SSI in this study.

Incidence and risk factors for incisional surgical site infection in patients with Crohn’s disease undergoing bowel resection

Background:Patients with Crohn’s disease(CD)are often reported to be at a high risk for incisional surgical site infection(SSI).The aim of this study was to identify the risk factors associated with post-operative incisional SSI in CD patients after bowel resection.Method:CD patients undergoing bowel resection between 2007 and 2015 were enrolled.Demographic and clinical features related to post-operative incisional SSI were analysed using both univariate and multivariate logistical analyses.Results:Of all eligible patients(n=159),123(77.4%)were male,with a mean age at surgery of 33.4611.8 years.A total of 35(22.0%)CD patients developed post-operative incisional SSI.Post-operative incisional SSI was more likely to happen in patients who had penetrating type of disease(P=0.018),underwent bowel resection for the indication of chronic fistula(P=0.005)and had an intra-operative finding of fistula(P=0.001).A greater proportion of patients with post-operative incisional SSI were found to have anemia(P=0.019)but elevated levels of white blood cells(P=0.027),neutrophils(P=0.006)as well as an elevated percentage of neutrophils(P=0.005).Multivariate logistic regression analysis showed that anemia(odds ratio[OR]:3.31,95%confidence interval[CI]:1.05-10.46,P=0.041),an elevated percentage of neutrophils(OR:2.85,95%CI:1.23-6.59,P=0.014)and an intra-operative finding of fistula(OR:3.76,95%CI:1.53-9.21,P=0.004)were significantly associated with the risk for post-operative incisional SSI.Conclusions:Anemia,elevated percentage of neutrophils and intra-operative finding of fistula are predictors for the development of post-operative incisional SSI in CD patients undergoing bowel resection.Favorable pre-operative nutrition status and low inflammatory status may lessen the incidence of post-operative incisional SSI.

Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula.AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures.METHODS In this retrospective study,525 patients with anorectal abscesses treated by incision and drainage alone,at a tertiary general hospital from August 2012 to July 2022,were included.A new classification for anorectal abscesses based on their propensity to develop into fistulas,considering 18 other potential risk factors,was established.These factors,from electronic medical records,were screened for significance using theχ^(2)test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses.RESULTSOne year post-follow-up,the overall recurrence rate was 39%:81.0%and 23.5%for fistula-prone and non-fistulaproneabscesses,respectively.Univariateχ^(2)analysis showed significant differences in recurrence rates based onanatomical classifications and pus culture results(P<0.05).Fistula-prone abscess,≥7 days between symptomonset and surgery,chronic diarrhea,preoperative antibiotic use,and local anesthesia were risk factors for recurrence,while diabetes mellitus was protective(P<0.05).Moreover,fistula-prone abscess[odds ratio(OR)=7.651,95%CI:4.049–14.458,P<0.001],≥7 days from symptom onset to surgery(OR=2.137,95%CI:1.090–4.190,P=0.027),chronic diarrhea(OR=2.508,95%CI:1.216–5.173,P=0.013),and local anesthesia(OR=2.308,95%CI:1.313–4.059,P=0.004)were independent risk factors for postoperative anorectal abscess recurrence using multivariatelogistic regression.Body mass index≥28(OR=2.935,95%CI:1.203–7.165,P=0.018)was an independentrisk factor for postoperative recurrence of non-fistula-prone abscess.CONCLUSIONThe choice of surgical procedure for treating anorectal abscesses should follow this new classification.Prompt andthorough incision and drainage can significantly reduce postoperative recurrence.

Correlative factor of death in patients with infected pancreatic necrosis after surgical intervention

Background:Acute pancreatitis(AP)was a potentially fatal disease with a variation in severity.Infected pancreatic necrosis was a common complication in AP which needed surgical intervention.The present study was to study the correlative factors of death in patients with infected pancreatic necrosis after surgical intervention.Methods:From January 2016 to October 2019,a total of 186 patients with infected pancreatic necrosis after surgical intervention in the First Medical Center,Chinese PLA General Hospital were retrospectively enrolled in this study.Of the 186 patients,22 who died in the hospital were defined as a mortality group and the others as a survival group.The clinical characteristic of the 2 groups was compared and the relative risk of mortality in patients with infected pancreatic necrosis after the surgical intervention was studied.Results:Acute fluid collection,acute kidney injury,acute lung injury,acute liver injury,multiple organ dysfunction syndromes,abdominal bleeding,abdominal Acinetobacter baumannii infection,pulmonary infection,pulmonary A baumannii infection,positive blood culture,A baumannii of blood culture,severe acute pancreatitis according to Atlanta 2012,the use of continuous renal replacement therapy,mechanical ventilation and minimally invasive retroperitoneal pancreatic necrosectomy was associated with death in hospital.Older age,longer acute kidney injury lasting time,longer acute lung injury lasting time,longer acute liver injury lasting time,and longer multiple organ dysfunction syndromes lasting time in predicting mortality in patients with infected pancreatic necrosis after surgical intervention were(0.635[95%confidence interval(CI):0.512-0.758],P=.040),(0.877[95%CI:0.788-0.965],P=.000),(0.932[95%CI:0.897-0.968],P=.000),(0.822[95%CI:0.708-0.935],P=.000),and(0.943[95%CI:0.887-0.998],P=.000).Due to the small number of death cases,the results of the multivariate analyses were not available.Conclusion:In this single-center retrospective study of 186 cases of infected pancreas necrosis,the correlative factors of death are identified.The results warranted further strategies are needed especially focusing on elder patients to prevent blood infection and to protect the functions of vital organs.

外科手术患者术后切口感染的危险因素分析

目的分析外科手术患者术后切口感染的危险因素。方法回顾性分析2022年1月至2022年12月于九江市第一人民医院进行外科手术治疗的256例患者的临床资料,所有入选者均进行相应的手术治疗,根据术后切口感染发生情况分组,比较两组相关资料,分析外科发生切口感染的相关因素。结果256例患者中,有20例发生切口感染,术后切口感染发生率为7.81%(20/256)。单因素分析结果显示,感染组年龄>60岁、合并糖尿病、术前贫血、手术时间≥3 h、急诊手术、围手术期输血占比均高于未感染组,差异有统计学意义(P<0.05)。logistic回归分析结果显示,年龄>60岁(OR=6.316,95%CI=2.214~18.018,P=0.001)、合并糖尿病(OR=4.787,95%CI=1.877~12.209,P=0.001)、术前贫血(OR=4.756,95%CI=1.860~12.163,P=0.001)、手术时间≥3 h(OR=6.367,95%CI=2.458~16.491,P<0.001)、急诊手术(OR=6.574,95%CI=2.547~16.968,P<0.001)、围手术期输血(OR=5.441,95%CI=2.111~14.024,P<0.001)是外科手术患者术后切口感染的独立危险因素(P<0.05,OR>1)。结论手术为重要的治疗方法,但因本身具有创伤性,术后切口感染发生率较高,对于年龄>60岁、合并糖尿病、术前贫血、手术时间≥3 h、急诊手术、围手术期输血的患者,需重点管理,尽可能降低切口感染发生率。

基于措施优先级的失效模式和效应分析在结直肠术手术部位感染防控中的应用

目的评估结直肠手术后手术部位感染(SSI)防控措施执行的过程风险,探讨基于措施优先级的失效模式和效应分析(FMEA)的应用效果。方法应用基于措施优先级的FMEA评估结直肠手术后SSI防控措施执行的整个流程,对是否采取优化措施进行优先级排序,比较FMEA实施前后结直肠手术SSI防控措施依从项达标率、SSI发病率。结果评估后SSI高优先级防控措施7项,中优先级22项,对中优先级措施加强控制,重点对高优先级措施制定进一步的预防和可探测措施。改进后再评价结果显示,7项高优先级措施降至中优先级;16项中优先级措施降至低优先级。SSI防控措施执行达标率由77.15%(2566/3326)提高至92.47%(3096/3348),SSI发病率由6.04%(58/960)降至2.54%(60/2364)。结论运用基于措施优先级的FMEA可对结直肠手术SSI防控过程进行有效风险评估,并结合现状针对性采用预防性风险控制措施,可降低结直肠手术SSI发病率。

老年股骨颈骨折患者髋关节置换术后手术部位感染的危险因素分析

目的 评估老年股骨颈骨折患者行髋关节置换术后手术部位感染的危险因素,为有效地预防老年股骨颈骨折术后手术部位感染提供参考依据。方法 选取漯河医学高等专科学校第二附属医院2018年1月-2023年3月收治的老年股骨颈骨折患者350例,均行髋关节置换手术治疗,根据术后手术部位感染情况分为感染组22例,未感染组328例;比较2组患者的一般情况、手术方式、手术时间、基础疾病,归纳老年股骨颈骨折患者术后手术部位感染的影响因素。结果 高龄(>80岁)、肥胖、低蛋白血症和糖尿病是老年髋部骨折患者术后感染的危险因素(P<0.05)。结论 高龄、肥胖、低蛋白血症和基础疾病是老年股骨颈骨折患者术后手术部位感染的危险因素,应加强相关监管;对于怀疑手术部位感染的患者,应积极送检病原菌培养,重视真菌及分枝杆菌可提高病原菌检出率。