Surgical site infection following abdominal surgery in China: a multicenter cross-sectional study.

Zhiwei Wang; Jun Chen; Jianan Ren; Peige Wang; Zhigang Jie; Weidong Jin; Jiankun HU; Yong LI; Jianwen Zhang; Shuhua LI; Jiancheng TU; Haiyang Zhang; Hongbin Liu; Liang Shang; Jie Zhao; Suming Luo; Hongliang Yao; Baoqing Jia; Lin Chen; Zeqiang Ren; Guangyi LI; Hao Zhang; Zhiming WU; Daorong Wang; Yongshun Gao; Weihua FU; Hua Yang; Wenbiao Xie; Erlei Zhang; Yong Peng; Shichen Wang; Jie Chen; Junqiang Zhang; Tao Zheng; Gefei Wang

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Surgical site infection following abdominal surgery in China: a multicenter cross-sectional study.

Author: Zhiwei WANG ¹ ; Jun CHEN ² ; Jianan REN ³ ; Peige WANG ⁴ ; Zhigang JIE ⁵ ; Weidong JIN ⁶ ; Jiankun HU ⁷ ; Yong LI ⁸ ; Jianwen ZHANG ⁹ ; Shuhua LI ¹⁰ ; Jiancheng TU ¹¹ ; Haiyang ZHANG ¹² ; Hongbin LIU ¹³ ; Liang SHANG ¹⁴ ; Jie ZHAO ¹⁵ ; Suming LUO ¹⁶ ; Hongliang YAO ¹⁷ ; Baoqing JIA ¹⁸ ; Lin CHEN ¹⁸ ; Zeqiang REN ¹⁹ ; Guangyi LI ²⁰ ; Hao ZHANG ²¹ ; Zhiming WU ²² ; Daorong WANG ²³ ; Yongshun GAO ²⁴ ; Weihua FU ²⁵ ; Hua YANG ²⁶ ; Wenbiao XIE ²⁷ ; Erlei ZHANG ²⁸ ; Yong PENG ²⁹ ; Shichen WANG ³⁰ ; Jie CHEN ³¹ ; Junqiang ZHANG ³² ; Tao ZHENG ² ; Gefei WANG ²
Author Information

1. Jinling Medical Collage, Medical School of Nanjing University, Nanjing 210002, China.
2. East War Zone Hospital of PLA, Research Institute of General Surgery, Nanjing 210002, China.
3. East War Zone Hospital of PLA, Research Institute of General Surgery, Nanjing 210002, China. Email:jiananr@nju.edu.cn.
4. the Affiliated Hospital of Qingdao University, Department of Emergency General Surgery, Qingdao 266000, China.
5. the First Affiliated Hospital of Nanchang University, Department of Gastrointestinal Surgery, Nanchang 330000, China.
6. Central War Zone Hospital of PLA, Department of General Surgery, Wuhan 430000, China.
7. West China Hospital, Department of Gastrointestinal Surgery, Chengdu 610041, China.
8. Guangdong General Hospital, Department of Gastrointestinal Surgery, Guangzhou 510080, China.
9. Chenzhou First People's Hospital, Department of Cardio-Thoracic Surgery, Hunan Chenzhou 423000, China.
10. Zigong First People's Hospital, Department of General Surgery, Sichuan Zigong 643000, China.
11. Zhangjiagang First People's Hospital, Department of General Surgery, Jiangsu Zhangjiagang 215600, China.
12. Nanyang City Center Hospital, Department of General Surgery, Henan Nanyang 473003, China.
13. Lanzhou General Hospital of Lanzhou Military, Department of General Surgery, Lanzhou 730050, China.
14. Shangdong Provincial Hospital, Department of General Surgery, Jinan 250021, China.
15. Shangqiu First People's Hospital, Department of General Surgery,Henan Shangqiu 476000, China.
16. People's Hospital of Xinjiang Uygur Autonomous Region, Department of Gastrointestinal Surgery, Urumqi 830001, China.
17. the Second Xiangya Hospital of Central South University, Department of Gastrointestinal Surgery, Changsha 410011, China.
18. Chinese PLA General Hospital, Department of General Surgery, Beijing 100039, China.
19. the Affiliated Hospital of Xuzhou Medical University, Department of General Surgery, Jiangsu Xuzhou 221006, China.
20. Hunan People's Hospital, Department of General Surgery, Changsha 410002, China.
21. Dongguan Kanghua Hospital, Department of General Surgery, Guangdong Dongguan 523080, China.
22. Shaoxing Central Hospital, Department of Hepatobiliary Surgery, Zhejiang Shaoxing 312000,China.
23. Northern Jiangsu People's Hospital, Department of General Surgery, Jiangsu Yangzhou 225001, China.
24. the First Affiliated Hospital of Zhengzhou University, Department of Gastrointestinal Surgery, Zhengzhou 450052, China.
25. General Hospital of Tianjin Medical University, Department of General Surgery, Tianjin 300052, China.
26. Zigong Fourth People's Hospital, Department of General Surgery, Sichuan Zigong 643000, China.
27. the Second Hospital, University of South China, Department of Tumor Surgery, Hengyang 421001, China.
28. Tongji Hospital, Department of General Surgery, Wuhan 430030, China.
29. Nanchong Central Hospital, Department of General Surgery, Sichuan Nanchong 637900,China.
30. the 901th Hospital of the PLA, Department of General Surgery, Hefei 230031, China.
31. Hunan Cancer Hospital, Department of Head and Neck Surgery, Changsha 410006, China.
32. Lanzhou University Second Hospital, Department of General Surgery, Lanzhou 730030, China.
Publication Type:Journal Article
MeSH: Abdomen; surgery; Adult; Aged; China; Cross-Sectional Studies; Female; General Surgery; statistics & numerical data; Humans; Male; Middle Aged; Operative Time; Postoperative Complications; prevention & control; Preoperative Period; Retrospective Studies; Risk Factors; Surgical Wound Infection; prevention & control
From: Chinese Journal of Gastrointestinal Surgery 2018;21(12):1366-1373
CountryChina
Language:Chinese
Abstract: OBJECTIVE:To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China.
METHODS:The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI.
RESULTS:A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI.
CONCLUSIONS:The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.