疾病控制中心 (CDC) 的伤口分类是手术后30天再入院的预后
Victoria Yin1, J Perren Cobb2, Sean C Wightman3
1Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA.
World journal of surgery
|July 5, 2023
概括
手术伤口分类显著预测了30天的再接收风险. 不干净的伤口类别,包括"干净/受污染"",受污染"和"脏/受感染",与"干净"伤口相比,与更高的再接收率有关.
科学领域:
- 手术结果研究研究.
- 患者安全 患者安全
- 医疗保健服务研究 医疗服务研究
背景情况:
- 术后再接收在手术护理中构成了重大挑战.
- 了解影响30天再入院的因素对于改善患者的治疗结果至关重要.
- 疾病预防控制中心的伤口分类是一个标准化的系统,用于分类手术场所污染.
研究的目的:
- 调查疾病控制中心 (CDC) 的伤口课程与30天再入院率之间的关联.
- 在一大批手术患者中确定30天再入院的风险因素.
- 评估伤口分类在预测再录取中的预后价值.
主要方法:
- 美国外科医生学院2017-2020年国家外科质量改进计划 (ACS-NSQIP) 数据库的分析.
- 包括接受重大外科手术的患者,包括整体关节置换,冠状动脉旁路移植,食道切除,胰腺双切除,远部胰腺切除,肺切除和切除术.
- 使用多变量通用线性混合回归模型来评估伤口类别对再入院的影响,并根据各种患者和手术因素进行调整.
主要成果:
- 总共分析了477,964例病例,其中8.1%的病例经历了30天的再入院.
- "清洁/受污染" (p < .001),"受污染" (p < .001) 和"脏/受感染" (p < .001) 的伤口类别与"清洁"伤口相比,与30天内再入院的增加显著相关.
- 在所有伤口类别中,器官/空间手术部位感染和败血症被确定为重新入院的常见原因.
结论:
- 手术伤口分类是30天再入院的强有力的预测因素.
- 具有"不清洁"伤口分类的程序具有显著更高的再接收风险.
- 传染性并发症是再入院的主要驱动因素,强调了优化抗生素策略和源控制的必要性.
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