X F Zhang1, J Chen1, P G Wang2, S M Luo3, N X Liu4, X M Li5, X L He6, Y Wang10, X G Bi8, P Zhang9, Y Wang10, Z C Lv11, B Zhou12, W Mai13, H Wu14, Y Hu15, D R Wang16, F W Luo17, L G Xia18, J J Lai19, D M Zhang20, Q Wang21, G Han22, X W Wu1, J A Ren1. 1. Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu 210002, China. 2. Department of Emergency Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China. 3. Department of Comprehensive Surgery, the People's Hospital of Xinjiang Uygur autonomous region, Urumqi, Xinjiang 830001, China. 4. Department of Pancreatitis Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China. 5. Department of General Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450007, China. 6. Department of General Surgery, the Second Affiliated Hospital of the Air Force Medical University, Xi'an, Shanxi 710038, China. 7. Department of General Surgery, Yichang Central People's Hospital, the First College of Clinical Medical Science of Three Gorges University, Yichang, Hubei 443003, China. 8. Department of Gastrointestinal and pancreatic Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China. 9. Department of Hepatobiliary Surgery, the First Hospital of Jilin University, Changchun, Jilin 130021, China. 10. Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China. 11. Department of General Surgery, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, China. 12. Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China. 13. Department of Gastrointestinal Surgery, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China. 14. Department of General Surgery, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China. 15. Department of Gastrointestinal Surgery, Sichuan People's Hospital, Chengdu, Sichuan 610072, China. 16. Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, China. 17. Department of Acute Abdominal Surgery, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, China. 18. Department of Gastrointestinal Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, China. 19. Department of Gastrointestinal Surgery, Yuebei people's hospital, Shaoguan, Guangdong 512026, China. 20. Department of General Surgery, Baotou Central Hospital, Baotou, Inner Mongolia 014040, China. 21. Department of Gastrointestinal Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China. 22. Department of Gastrointestinal Nutrition and Hernia Surgery, the Second Hospital of Jilin University, Changchun, Jilin 130041, China.
Abstract
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), χ(2)=54.999, P<0.001] and mortality within postoperative 30-day [1.84% (3/163) vs.0.01% (5/5397), χ(2)=33.642, P<0.001], longer ICU stay (median: 0 vs. 0, U=518 414, P<0.001), postoperative hospital stay (median: 17 days vs. 7 days, U=656 386, P<0.001), and total duration of hospitalization (median: 25 days vs. 12 days, U=648 129, P<0.001), and higher hospitalization costs (median: 71 000 yuan vs. 39 000 yuan, U=557 966, 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.
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), χ(2)=54.999, P<0.001] and mortality within postoperative 30-day [1.84% (3/163) vs.0.01% (5/5397), χ(2)=33.642, P<0.001], longer ICU stay (median: 0 vs. 0, U=518 414, P<0.001), postoperative hospital stay (median: 17 days vs. 7 days, U=656 386, P<0.001), and total duration of hospitalization (median: 25 days vs. 12 days, U=648 129, P<0.001), and higher hospitalization costs (median: 71 000 yuan vs. 39 000 yuan, U=557 966, 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.
Entities:
Keywords:
Abdominal surgery; Cross-sectional study; Risk factors; Surgical site infection