Analysis And Prevention Of Surgical Site Infection After Radical Resection For Gastric Cancer

Objective:Gastric cancer is one of the most common digestive tract malignant tumor in the world.China Japan and Korea are the High incidence area.In China,400000 people suffer from it each year which account for 42%of morbidity in the world.For the past few years,the morbidity and mortality of gastric cancer kept rising trend.Surgery is the preferred treatment for the most patient which can effectively remove the primary tumor,prolong patient survival time and keep the quality of life.But it also comes with a variety of complications which conclude wound infection.Surgical site infection is easy to be ignored,but it can extend the postoperative recovery,increase the hospital stay,waste medical resources,increase patients' economic burden,even delay the follow-up treatment to shorten the survival time.The incidence of wound infection after gastrectomy is high,nevertheless,there is no systematic study to analyse the high risk factors and compare the wastage between the two groups.So it is difficult to give specific guidance to prevent and treat it.The purpose of this research is to find the high risk factors about the surgical site infection after gastrectomy through the multiple factors which are divided into preoperative,intra-operative and postoperative groups.After that,we can guide and treatment in perioperative period and intra-operative period to effectively avoid the damage and loss about site infection.Methods:A total of 163 cases of patients who has been diagnosed gastric cancer and underwent radical surgery in Qilu Hospital of Shandong University from January 2014 to December 2015 were included in this retrospective study.The clinical data collected to identify the related clinical risk factors of wound infection includes:(1)preoperative factors:?gender(male=A,female=B);?age(continuous variable);?BMI(continuous variable);?hypertension(yes=A,no=B);?diabetes(yes=A,no=B);?previous abdominal surgery(yes=A,no=B);?smoking(yes=A,no=B);?preoperative protein level(continuous variable);?pyloric obstruction(yes=A,no=B);?preoperative laxatives(use=A,no=B)?(2)intra-operative factors:?length of site(continuous variable);?wound edge protector(use=A,no=B);?diameter of tumor(continuous variable);?transfusion(yes=A,no=B);?hypothermy(yes=A,no=B);?operation time(continuous variable);?chemotherapy drug(use=A,no=B);?rinse site(NS/iodine=A,with metronidazole=B);?subcutaneous drainage(use=A,no=B)?(3)postoperation factors:?blood glucose(continuous variable);?antibiotics(cephalosporin/penicillins/aminoglycosides=A,with nitroimidazoles=B);?dressing change in the next 2 days(yes=A,no=B)?(4)wastage information:?hospitalization cost;?hospitalization time?Results:(1)In the 163 patients,there are 25 cases wound infection,accounted for 15.3%,and 138 cases are not infected which accounted for 84.7%;(2)The Single-factor analysis shows that the risk factors include:diabetes(p<0.01),smoking(p<0.01),wound edge protector(p=0.054),chemotherapy drug(p=0.053),subcutaneous drainage(p=0.083),blood glucose(p<0.01)and dressing change in the next 2 days(p<0.01);(3)The multiariable logistic regression equation is:Y=5.434+1.155*smoking-1.241*(wound edge protector)-0.628*(blood glucose)-2.242*(dressing change in the next 2 days)(4)Goodness-of-fit test results show that the degree of fitting of the equation is good.Iteration records show that the iterative process of equations is smooth and no obvious fluctuations.(5)The hospitalization days and cost of the infected cases are more than the not infected ones(days:p<0.01,cost:p=0.047).Conclusion:(1)The incidence of wound infection after gastric cancer radical surgery is 15.3%,there are 25 patients infected in 163 cases;(2)diabetes(p<0.01),smoking(p<0.01),wound edge protector(p=0.054),chemotherapy drug(p=0.053),subcutaneous drainage(p=0.083),blood glucose(p<0.01)and dressing change in the next 2 days(p<0.0 1)are risk factors of wound infection postoperative,which can be as screening condition to select the susceptible populations.(3)The Logistic regression equation is:Y=5.434+1.155*smoking-1.241*(wound edge protector)-0.628*(blood glucose)-2.242*(dressing change in the next 2 days)...