Surveillance And Analysis Of Surgical Site Infection In Patients With Digestive System Neoplasms

Objective:To survey the situation of surgical site infection (SSI) in patients with digestive system neoplasms and its impact on hospital costs, explore the risk factors of SSI, so as to provide the evidence for effective measures to prevent SSIs and reduce the waste of medical resources.Method:1. Patients who developed SSIs from Janl,2013 to Dec 31,2015 were matched with those uninfected control patients. A Wilcoxon test was used to compare the overall costs of treatment and the length of hospital stay for cases and control patients.2. Through real-time surveillance and retrospective analysis,6059 patients who were diagnosed as digestive system neoplasms and underwent radical surgeries were identified. The incidence of nosocomial infections and SSIs, distribution of pathogens were explored and relevant factors of SSI were analyzed.3.906 cases undergoing laparotomy from Janl,2013 to Dec 31,2013 were enrolled to determine the clinical effectiveness of wound edge protection device in reducing surgical site infection after abdominal surgery.4.1629 patients who were diagnosed as digestive system neoplasms and underwent radical surgeries were followed up via telephone to monitor post-discharge SSIs and wound care.Results:1. The median additional length of hospital stay attributable to SSI was 17 days and the median additional cost attributable to SSI was 51019.92 Yuan, most of which was medication. Compared with uninfected cases, the cost patients with SSI only spent was about 1.7 times more, patients with SSI and other infections spent was about 2.6 times more, and patients with organ/space infections spent was about 2.01 times more.2. Nosocomial infections and SSI were detected in 588 patients and 274 patients, respectively. SSI ranked first in the nosocomial infections. SSI after gastric neoplasms was positively correlated with monthly mean maximum temperature. The incidence of SSI was positively correlated with surgeon volume. Diagnosis, surgical approach, surgery length, preoperative serum albumin were independent risk factors for SSI.3. Among 906 patients undergoing laparotomy,41 cases were identified, including 13 cases in the device group and 28 cases in the control group. Wound edge protection device did not reduce the rate of surgical site infection in patients undergoing laparotomy. The subgroup analysis found that Wound edge protection device may be efficient in reducing SSI rates in patients with rectal neoplasms.4. Among 1629 telephone follow-up,188 cases were lost in touch,17 cases were dead and 49 cases were identified as SSI, including 46 superficial incisional infections, 1 deep incisional infection and 2 organ/space infections.903(63.41%) cases managed their wounds at home,1084(76.12%)cases changed dressing 1/2-3d,30(61.22%)cases visit outpatient clinic after SSIs were developed.1001(70.29%) cases could not recall that a discharge information about SSI introduced to them,106(7.44%)cases stated that they didn't learned about SSI in hospital.Conclusions:1. SSI prolonged hospital stay and increased hospital costs. Organ/space infections which were associated with the highest healthcare cost should be focused on in clinical practice.2. SSI in patients with digestive system neoplasms accounted for 39.60% of nosocomial infections. Temperature, surgeon volume, diagnosis, surgical approach, surgery length and preoperative serum albumin were independently associated with SSI.3. Wound edge protection device was efficient in reducing SSI rates in patients with rectal neoplasms, but it did not reduce the rate of SSI in patients with gastric neoplasms and colon neoplasms.4. SSIs developed post-discharge were correlated with wound care at home. Therefore, better educational and engagement interventions incorporating patient preferences are needed to promote awareness and patient engagement regarding SSI prevention.