Analysis Of Risk Factors To Surgical Site Infection In General Surgery

Objective:Surgical site infection (SSI) is one of the most common postoperative complications and hospital onset of infection in surgical patients. SSI would affect the quality of medical care seriously, extend the length of hospital stay, enhance patient suffering, increase treatment costs, and threaten life. In recent years, with the changes of pathogen infection, the increasing of bacterial resistance against antibiotics, and the development of operation technique, the control of SSI is facing new challenges. Although it is difficult to inhibit SSI, it is important to reduce postoperative mortality and complications by reasonable and preventive ways through studying its risk factors.Methods:The situation of wound healing, consulted medical history, progress notes, laboratory tests, special examinations, bacteriological examination reports and other data were obtained from 748 patients undergoing general surgical operations, between July 12008 and September 30 2009 at the Second Affiliated Hospital of Dalian Medical University. The SSI was analyzed according to "diagnostic criteria of nosocomial infection (Trial)".Age, sex, diabetes mellitus, combined with other underlying diseases, preoperative ASA classification, the degree of pollution of surgical incision, timing of operation, operating time, blood loss and blood transfusion, and preoperative prophylactic use of antimicrobial drugs were observed in our studies. Statistical significance was established by Logistic regression, Enter, and Backward-LR regression tests using SPSS13.0 software.Results:A total of 23 (3.07%) patients developed SSI. The superficial wound infection, deep wound infection and organs (lacuna) infection were identified in 15,6, and 2 of the 748cases, respectively. Time of infection after surgery was 3-12d, an average of 5.6±2.6d. The rate of SSI in male patients was 3.98%, and in female was 2.27%. The rate of SSI in diabetic, in non-diabetic, in patients associated with other underlying diseases (hypertension, COPD, etc.), and in the patients not accompanied by other basic diseases was 17.07%,2.26%,7.41%, and 2.55%, respectively. The SSI rate of patients with ASA grade I, grade II, grade III, and grade IV was 1.51%,9.80%,26.92%, and 14.29%respectively. The SSI rate of patients with gradeⅤwas not observed. The SSI rate of typeⅠ, typeⅡ, typeⅢincision was 0.47%,5.91%, and 7.69% respectively. The SSI rate of emergency surgery and non-emergency surgery rate was 5.63%, and 2.48% respectively. The SSI rate in patients with and without blood transfusion was 7.14%, and 2.83% respectively. The SSI rate was 5.262% after unreasonable preoperative prophylaxis, and the rate was 2.00% in using appropriate case. The average age of occurrence of SSI was 61.0±11.8 years-old, mean operative time was 188.5±142.9mins.Data analysis was conducted using Logistic regression methods:sex (P= 0.090, OR value= 2.371), age (P= 0.037, OR value= 1.028), diabetes mellitus (P= 0.003, OR value= 6.456), ASA points level (P= 0.000, OR value=2.832), surgical incision pollution levels (P= 0.000, OR value= 3.929), timing of operation (P=0.088, OR value= 2.469).Conclusions:This study suggests that SSI risk factors are associated with the followings:(1) Incidence of SSI has a gender-related of men than women, it may be related to lifestyle of patients;(2) Advanced age, diabetes, ASA score higher, poor wound cleanliness emergency surgery are risk factors for SSI.