| ObjectivesTo explore the risk factors of surgical-site infection(SSI)among patients undergoing glioma surgery systematically by learning about the current situation of healthcare-associated infection(HAI)in the target population.Moreover,the direct economic burden and indirect economic burden of HAI were evaluated in order to provide a scientific basis for neurosurgical clinicians to take effective measures timely to reduce the cases of HAI,and theoretical support for the health administrative department to formulate the relevant preventive and control measures to achieve the rational allocation of medical and health resources.MethodsAll the eligible patients hospitalized in the general hospital from January 1,2015 to December 31,2018 were recruited,a total of 588 cases were included.Using the method of target monitoring,the patients' related data was filled in the self-designed questionnaires:?Target surveillance investigation forms of healthcare-associated infection in patients undergoing glioma surgery?,if the surgical patients acquired healthcare-associated infection,then the relevant information were filled in the two questionnaires:?Survey on healthcare-associated infection in patients undergoing glioma surgery?and?Survey on the economic burden of healthcare-associated infection in patients undergoing glioma surgery?.The research contains following aspects:the current situation of HAI,risk factors of SSI and economic burden caused by HAI;(1)Risk factor for SSI:mean,standard deviation,median,rate and percentage were used for statistical description;T test,Chi-square test,Fisher exact probability and Mann-Whitney U test were used to describe difference between groups.Logistic regression was used for risk factors analysis.(2)Economic burden evaluation of HAI and SSI:using propensity score weighting(PSW)to caculate the economic burden caused by HAI;1:1 matching was carried out by using the propensity score matching(PSM),and the economic burden caused by the various HAI was evaluated by Wilcoxon rank sum test.Results1.588 patients were recruited in this study,including 323 males(54.93%)and 265 females(45.07%).the average age of the target population was 49.18±13.28 years old.2.A total of 145 cases(155 episodes)were identified with the incidence of healthcare-associated infection reaching 24.66%,and the incidence of healthcare-associated infection cases was 26.36%.SSI was the most common healthcare-associated infection site with 122 cases(composition ratio 84.14%),followed by multi-site infection with 10 cases(composition ratio 6.90%),hospital-acquired pneumonia with 9 cases(composition ratio 6.21%)and urinary tract infection(UTI)with 4 cases(composition ratio 2.76%).3.A total of 58 strains of pathogenic bacteria were detected in 887 clinical samples after operation.Among them,39 strains(67.24%)were Gram-positive bacteria,among which Streptococcus viridans and Staphylococcus epidermidis were the most common;18 strains(31.03%)were Gram-negative bacteria,Acinetobacter baumannii was the most common;and the rest 1 strain was fungi(1.72%).4.The 5 independent risk factors of SSI among patients undergoing glioma surgery were determined by Logistic regression:neutrophils ratio,lymphocyte ratio,operative grade(? level),the duration of antibiotic use and postoperative body temperature on the third day.5.The median direct hospitalization costs of glioma surgery patients in the HAI group was 68,042.13 yuan,while that of non-infection group was 46,362.42 yuan.The direct economic burden caused by HAI was 21,679.71 yuan,of which the proportion of western medicine was the highest(11.929.23 yuan);the indirect economic burden of one HAI case was 2,611.00 yuan.Besides,prolonged length of stay reached 7 days due to HAI.6.The median direct hospitalization costs of glioma surgery patients in the SSI group was 66,861.65 yuan,while that of non-infection group was 50,941.15 yuan.The direct economic burden caused by SSI was 14,739.39 yuan,of which the proportion of western medicine was the highest(8,180.08 yuan);the indirect economic burden of one SSI case was 2,238.00 yuan.Besides,prolonged length of stay reached 6 days due to SSI.ConclusionsThe incidence of HAI in patients undergoing glioma surgery is quite high,especially the incidence of SSI,so the glioma patients should be the key of HAI monitoring.Neutrophil ratio,lymphocyte ratio,operative grade(? level),the duration of antibiotic use and postoperative body temperature on the third day are the independent risk factors for SSI in patients undergoing glioma surgery.Therefore,targeted prevention and control measures should be taken against these risk factors to reduce the incidence of SSI in the target population. |
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