1.Analysis of in-service occupational medical examination results during employment for high-temperature workers in Longhua District, Shenzhen City
Fuling CAI ; Hongxin LV ; Zhiheng XU ; Shichen WU
China Occupational Medicine 2025;52(2):228-231
		                        		
		                        			
		                        			Objective To investigate the health status of high-temperature workers in Longhua District, Shenzhen City. Methods A total of 10 323 high-temperature workers in Longhua District from 2019 to 2022 were selected as the research subjects using the judgment sampling method. Their in-service occupational medical examination results during employment were collected and analyzed by grouping. Results The abnormal rates of urinalysis, blood pressure, serum alanine aminotransferase (ALT), electrocardiogram (ECG), and blood glucose among the research subjects were 34.9%, 12.5%, 8.5%, 7.6%, and 7.2%, respectively. Women had a higher rate of abnormal urinalysis than men (63.0% vs 25.9%, P<0.01), while men had higher rates of abnormal blood pressure and serum ALT than women (13.5% vs 9.4%, 10.2% vs 3.1%, both P<0.01). The abnormal rates of urinalysis, blood pressure, ECG, and blood glucose among the research subjects increased with age (all P<0.05), while the abnormal rate of serum ALT decreased with age (P<0.01). The abnormal rates of blood pressure and blood glucose increased with the length of high-temperature work time (all P<0.01). The most common occupation exposed to high temperatures was injection molding (accounting for 22.2%). The abnormal rates of urinalysis, blood pressure, serum ALT, ECG, and blood glucose among different occupations had significant differences (all P<0.01). Among them, injection molding workers had the highest rate of abnormal urinalysis (43.5%), while inflation film workers had the highest rate of abnormal blood pressure (24.2%). Conclusion The health status of high-temperature workers in Longhua District is concerning. Priority should be given to addressing abnormalities in urinalysis, ALT, ECG, blood pressure, and blood glucose. Occupational medical examinations should focus on elder workers and those with long high-temperature work time. 
		                        		
		                        		
		                        		
		                        	
2.A multicenter clinical study of 280 cases of staphylococcal peritoneal dialysis-associated peritonitis
Xinyang LI ; Liming YANG ; Xueyan ZHU ; Xiaoxuan ZHANG ; Jing ZHAO ; Shichen LIU ; Xiaohua ZHUANG ; Yanfeng WU ; Ping LUO ; Wenpeng CUI
Chinese Journal of Nephrology 2021;37(4):321-326
		                        		
		                        			
		                        			Objective:To investigate the incidence, drug sensitivity and drug resistance characteristies, and theraputic effect of staphylococcal peritoneal dialysis-associated peritonitis (PDAP), aim to provide clinical evidences for standardizing treatment therapy of staphylococcal PDAP. Methods:Clinical data of PDAP patients admitted to the Second Hospital of Jilin University, the First Hospital of Jilin University-the Eastern Division, Jilin Central Hospital and Jilin First Automobile Work General Hospital during January 1, 2013 and December 31, 2019 were retrospectively collected. The results of etiology, drug sensitivity and drug resistance of staphylococcal PDAP patients were collected. According to the pathogenic bacteria, patients were divided into staphylococcus aureus group ( n=48) and coagulase-negative staphylococcus group ( n=232). According to the results of methicillin resistance, patients were divided into drug-resistant group ( n=71) and drug-sensitive group ( n=30). The prognosis of antibiotic therapy in each group were compared. Poisson regression was used to test the changing trend of the incidence of staphylococcal PDAP. The changes of drug sensitivity and drug resistance of staphylococcus were compared between 2013 and 2019 by linear trend χ2 test. Results:A total of 1 085 cases of PDAP occurred in 625 patients were screened, and 280 cases of staphylococcal PDAP were finally included. The incidences of staphylococcal PDAP, staphylococcus aureus PDAP and coagulase-negative staphylococcal PDAP were 0.063 times per patient year, 0.010 times per patient year and 0.053 times per patient year respectively. In addition, the incidence of PDAP caused by staphylococcus, staphylococcus aureus and coagulase-negative staphylococcus decreased year by year (all P<0.05). With the change of years, the sensitivity rate of staphylococcus to rifampicin increased, while the sensitivity rate of staphylococcus to moxifloxacin decreased (both P<0.05). The drug resistance rate of staphylococcus to levofloxacin increased ( P<0.05). The staphylococcus aureus group was more prone to refractory PDAP and catheter removal than that in coagulase-negative staphylococcus group, and the recurrence rate was higher than that in coagulase-negative staphylococcus group (all P<0.05). The proportion of vancomycin used during the whole course of antibiotic therapy in drug-resistant group was higher than that in drug-sensitive group ( P<0.05). Conclusions:The incidence of staphylococcal PDAP decreases year by year, and the drug sensitivity characteristics of staphylococcus also change. The therapeutic outcomes of staphylococcus aureus PDAP are worse than that of coagulase-negative staphylococcus.
		                        		
		                        		
		                        		
		                        	
3.Sleep status associated with psychological and behavioral problems in adolescents and children
Qianling WANG ; Xindong ZHANG ; Xiaoyan WU ; Qiang ZHANG ; Yi ZHANG ; Jian SUN ; Shichen ZHANG ; Xi WANG ; Qiao ZONG ; Shuman TAO ; Renjie WANG ; Fangbiao TAO
Chinese Journal of Epidemiology 2021;42(5):859-865
		                        		
		                        			
		                        			Objective:To examine whether sleep status and social jet lag are related to the mental health behaviors in children and adolescents, providing a reference for preventing and improving children and adolescents' mental health behaviors.Methods:A large cross-section was conducted in Baoan District, Shenzhen, from April to May 2019. A total of 30 188 adolescents and children in grades 1-12 in 14 schools were included. The growth trajectory and health index questionnaire of primary and secondary school students were designed to evaluate the sleep status. Mental health behavior problems among students were accessed using the parents' and students' versions of the Strengths and Difficulties Questionnaire. After controlling for confounding factors of demographic variables, including gender, age, parental education level, academic performance, learning burden, and noise impact, a multivariate logistic regression model was used for statistical analyses.Results:The sleep duration of four grades students were 90.4%,90.1%, 98.2%, and 98.4%, respectively. 19.9% did not have a post-lunch nap. 19.6% had a wake-up delay of more than or equal to 2 h weekend morning. 35.1% had an inconsistent bedtime and 15.5% had an inconsistent awakening time. The multivariate logistic regression model showed that compared with 8-9 h, the sleep duration of elementary school juniors at night less than or equal to 7 h, 7-8 h increased the risk of psychological behavior problems. The sleep time more than 9 h was negatively correlated with psychological behavior problems. The sleep duration of elementary school seniors less than or equal to 7 h increased the risk of psychological behavior problems. The sleep duration of middle school and high school students less than or equal to 6 h increased psychological behavior problems. The ORs (95% CI) appeared as 2.53(1.85-3.47), 2.41(1.11-5.25), respectively. The ones with a sleep time more than 9 h also increased the risk, and ORs (95% CI) appeared as 2.37(1.40-4.01), 5.38 (1.79-16.1), respectively. Both the absence of post-lunch nap and the nap time less than 0.5 h were risk factors for psychological behavior problems in primary and middle school students. The nap time over 1-2 h was also a risk factor for high school students' psychological behavior problems. Waking up at irregular times in the morning, going to bed at varying times in the evening, and delaying getting up for more than or equal to 2 h on weekends were all risk factors for psychological and behavioral problems among primary and middle school students. The ORs (95% CI) of psychological behavior problems of elementary school juniors and seniors, middle school and high school students were 2.07 (1.45-2.97), 1.57 (1.09-2.26), 2.66 (2.06-3.44), 2.48 (1.96-3.15), respectively. Conclusions:Sleep duration, no post-lunch sleep, and daily intraindividual variability of sleep is positively associated with poor mental health. Additionally, social jet lag is associated with mental health problems in students. It is noted that delaying sleep within half an hour on the weekends of elementary school juniors is significantly associated with an increase in bad mental behavior.
		                        		
		                        		
		                        		
		                        	
4.Prognosis analysis of local recurrence after excision of breast phyllodes tumors
Yuan PENG ; Yuanyuan ZHANG ; Shichen WANG ; Jinbo WU ; Fuzhong TONG ; Peng LIU ; Yingming CAO ; Bo ZHOU ; Lin CHENG ; Miao LIU ; Hongjun LIU ; Jiajia GUO ; Fei XIE ; Houpu YANG ; Siyuan WANG ; Chaobin WANG ; Shu WANG
Chinese Journal of Surgery 2021;59(2):116-120
		                        		
		                        			
		                        			Objective:To examine treatment outcomes of breast phyllodes tumors and the prognosis factors of local recurrence.Methods:This retrospective cohort study included 276 patients who underwent surgical resection at Breast Center, Peking University People′s Hospital from January 2011 to December 2019. Tumor subtype and histopathological features were determined from pathology reports, and the deadline of follow-up was September 30 th, 2020. All 276 patients underwent open surgery, including 17 patients of mastectomy, and 259 patients of lumpectomy. The enrolled patients were all female, with age of (41.5±11.3) years (rang: 11 to 76 years), and tumor diameter of 35(28) mm ( M( Q R)). The Kaplan-Meier method and Log-rank test were used for survival analysis. The multivariate analysis was implemented using the Cox proportional hazard model. Results:According the pathologic test, there were 191 patients of benign phyllodes tumor, 67 patients of borderline tumor and 18 patients of malignant tumor. There were 249 patients with a follow-up of more than 6 months, and 14.1% (35/249) had local recurrence. The time-to-recurrence was (28.6±22.2) months (range: 2 to 96 months), (29.1±18.1) months (range: 2 to 80 months), (32.1±30.1) months (range: 5 to 96 months) and (12.0±6.9) months (range: 8 to 20 months) for benign, borderline and malignant phyllodes tumors. Tumor diameter (≥100 mm vs.<50 mm, HR=3.968, 95%CI: 1.550 to 10.158, P=0.004) and malignant heterologous element (yes vs. no, HR=26.933, 95%CI: 3.105 to 233.600, P=0.003) were prognosis factors of local recurrence. One death from malignant phyllodes occurred after distant metastasis. The 3-year disease-free survival rates of benign, borderline and malignant phyllodes tumor were 88.2%, 81.7% and 81.4% ( P=0.300). Conclusion:Phyllodes tumors have a considerable local recurrence rate, which may be associated with tumor diameter and malignant heterologous element.
		                        		
		                        		
		                        		
		                        	
5.The relationship between migration time and the prevalence of myopia of children and adolescents aged 6-18 years old in Shenzhen
Renjie WANG ; Qiang ZHANG ; Xiaoyan WU ; Xindong ZHANG ; Shaojun XU ; Jian SUN ; Shichen ZHANG ; Xi WANG ; Qiao ZONG ; Shuman TAO ; Danlin LI ; Wenwen LIU ; Juan TONG ; Tingting LI ; Qianling WANG ; Yi ZHANG ; Fangbiao TAO
Chinese Journal of Preventive Medicine 2021;55(4):460-464
		                        		
		                        			
		                        			Objective:To analyze the relationship between migration time and the prevalence of myopia of children and adolescents aged between 6 and 18 years old in Shenzhen.Methods:From April to May 2019, 26 618 children and adolescents from 14 schools in six streets of Baoan District, including Fuyong, Shajing, Xin′an, Xixiang, Songgang and Shiyan, were included in the study by using random cluster sampling method. The demographic characteristics, migration status, self-reported myopia, screen time in the last seven days, outdoor activities in the last one month and other information were collected through the questionnaire. The differences of myopia among children and adolescents with different characteristics were compared by χ 2 test, and the relationship between migration time and the prevalence of myopia was analyzed by multivariate unconditional logistic regression model. Results:The age of 26 618 study participants was (12.37±3.49) years old, and the overall prevalence of myopia was 49.4%. Multivariate logistic regression analysis showed that after controlling for relevant confounding factors, compared with migrant children and adolescents of migrant workers who migrated for 1-2 years, those of migrant workers who had migrated for more than 6 years had a higher risk of myopia [ OR (95% CI): 1.48 (1.14-1.92)]. After being grouped by phase of school, in the lower grade group of primary school, the children and adolescents of migrant workers who had migrated for more than 6 years had a higher risk of myopia compared with those of migrant workers who migrated for 1-2 years [ OR (95% CI): 1.96 (1.20-2.74)]. In the high school group, compared with the children and adolescents of migrant workers who migrated for 1-2 years, those of migrant workers who had migrated for 3-5 years and ≥6 years had a higher risk of myopia [ OR (95% CI): 6.03 (1.29-28.15) and 6.52 (1.51-28.11), respectively]. Conclusion:The migration time is related to the prevalence of myopia of the children and adolescents of migrant workers.
		                        		
		                        		
		                        		
		                        	
6.Prognosis analysis of local recurrence after excision of breast phyllodes tumors
Yuan PENG ; Yuanyuan ZHANG ; Shichen WANG ; Jinbo WU ; Fuzhong TONG ; Peng LIU ; Yingming CAO ; Bo ZHOU ; Lin CHENG ; Miao LIU ; Hongjun LIU ; Jiajia GUO ; Fei XIE ; Houpu YANG ; Siyuan WANG ; Chaobin WANG ; Shu WANG
Chinese Journal of Surgery 2021;59(2):116-120
		                        		
		                        			
		                        			Objective:To examine treatment outcomes of breast phyllodes tumors and the prognosis factors of local recurrence.Methods:This retrospective cohort study included 276 patients who underwent surgical resection at Breast Center, Peking University People′s Hospital from January 2011 to December 2019. Tumor subtype and histopathological features were determined from pathology reports, and the deadline of follow-up was September 30 th, 2020. All 276 patients underwent open surgery, including 17 patients of mastectomy, and 259 patients of lumpectomy. The enrolled patients were all female, with age of (41.5±11.3) years (rang: 11 to 76 years), and tumor diameter of 35(28) mm ( M( Q R)). The Kaplan-Meier method and Log-rank test were used for survival analysis. The multivariate analysis was implemented using the Cox proportional hazard model. Results:According the pathologic test, there were 191 patients of benign phyllodes tumor, 67 patients of borderline tumor and 18 patients of malignant tumor. There were 249 patients with a follow-up of more than 6 months, and 14.1% (35/249) had local recurrence. The time-to-recurrence was (28.6±22.2) months (range: 2 to 96 months), (29.1±18.1) months (range: 2 to 80 months), (32.1±30.1) months (range: 5 to 96 months) and (12.0±6.9) months (range: 8 to 20 months) for benign, borderline and malignant phyllodes tumors. Tumor diameter (≥100 mm vs.<50 mm, HR=3.968, 95%CI: 1.550 to 10.158, P=0.004) and malignant heterologous element (yes vs. no, HR=26.933, 95%CI: 3.105 to 233.600, P=0.003) were prognosis factors of local recurrence. One death from malignant phyllodes occurred after distant metastasis. The 3-year disease-free survival rates of benign, borderline and malignant phyllodes tumor were 88.2%, 81.7% and 81.4% ( P=0.300). Conclusion:Phyllodes tumors have a considerable local recurrence rate, which may be associated with tumor diameter and malignant heterologous element.
		                        		
		                        		
		                        		
		                        	
7.The relationship between migration time and the prevalence of myopia of children and adolescents aged 6-18 years old in Shenzhen
Renjie WANG ; Qiang ZHANG ; Xiaoyan WU ; Xindong ZHANG ; Shaojun XU ; Jian SUN ; Shichen ZHANG ; Xi WANG ; Qiao ZONG ; Shuman TAO ; Danlin LI ; Wenwen LIU ; Juan TONG ; Tingting LI ; Qianling WANG ; Yi ZHANG ; Fangbiao TAO
Chinese Journal of Preventive Medicine 2021;55(4):460-464
		                        		
		                        			
		                        			Objective:To analyze the relationship between migration time and the prevalence of myopia of children and adolescents aged between 6 and 18 years old in Shenzhen.Methods:From April to May 2019, 26 618 children and adolescents from 14 schools in six streets of Baoan District, including Fuyong, Shajing, Xin′an, Xixiang, Songgang and Shiyan, were included in the study by using random cluster sampling method. The demographic characteristics, migration status, self-reported myopia, screen time in the last seven days, outdoor activities in the last one month and other information were collected through the questionnaire. The differences of myopia among children and adolescents with different characteristics were compared by χ 2 test, and the relationship between migration time and the prevalence of myopia was analyzed by multivariate unconditional logistic regression model. Results:The age of 26 618 study participants was (12.37±3.49) years old, and the overall prevalence of myopia was 49.4%. Multivariate logistic regression analysis showed that after controlling for relevant confounding factors, compared with migrant children and adolescents of migrant workers who migrated for 1-2 years, those of migrant workers who had migrated for more than 6 years had a higher risk of myopia [ OR (95% CI): 1.48 (1.14-1.92)]. After being grouped by phase of school, in the lower grade group of primary school, the children and adolescents of migrant workers who had migrated for more than 6 years had a higher risk of myopia compared with those of migrant workers who migrated for 1-2 years [ OR (95% CI): 1.96 (1.20-2.74)]. In the high school group, compared with the children and adolescents of migrant workers who migrated for 1-2 years, those of migrant workers who had migrated for 3-5 years and ≥6 years had a higher risk of myopia [ OR (95% CI): 6.03 (1.29-28.15) and 6.52 (1.51-28.11), respectively]. Conclusion:The migration time is related to the prevalence of myopia of the children and adolescents of migrant workers.
		                        		
		                        		
		                        		
		                        	
8.Evaluation and application of Brief Instrument on Psychological Health of Youths
TAO Shuman,WAN Yuhui,WU Xiaoyan,SUN Ying,XU Shaojun,ZHANG Shichen,HAO Jiahu,TAO Fangbiao
Chinese Journal of School Health 2020;41(9):1331-1334
		                        		
		                        			Objective:
		                        			To simplify the psychological domain of Multidimensional Sub-health Questionnaire of Adolescents (MSQA),which includes 39 items and develop the Brief Instrument On Psychological Health of Youths(BIOPHY), as well as to evaluate the predictive validity of the BIOPHY.
		                        		
		                        			Methods:
		                        			A total of 14 221 students were recruited from Shenyang,Xinxiang,Guangzhou,and Chongqing by using multistage stratified cluster random sampling to participate in the study. A combination of item analysis,factor analysis and reliability evaluation were used to screen items and evaluate the questionnaire. Meantime, data from 14 500 adolescents from Shenzhen,Nanchang,Zhengzhou and Guiyang in 2017 were used to develop a cut-off point and to evaluate its predictive validity.
		                        		
		                        			Results:
		                        			On the basis of item analysis,BIOPHY consisted of 15 items. Variance cumulative contribution rate was 57.39%; internal consistency test showed that the total questionnaire Cronbach α coefficient was 0.928. The split-half coefficient of the total questionnaire was 0.909. The 90th percentile of total scores was used as the cutoff point of BIOPHY. The results of multivariate logistic regression analysis showed that students with psychological health symptoms were at significantly higher risk of depressive symptoms (OR=10.53,95%CI=9.28-11.94),suicide ideations (OR=5.77,95%CI=5.15-6.46),suicide plans (OR=6.09,95%CI=5.39-6.89) and suicide attempts (OR=4.80,95%CI=4.04-5.69) than normal counterparts.
		                        		
		                        			Conclusion
		                        			The BIOPHY is consistent with the evaluation standard of psychometrics. The predictive validity of BIOPHY is good and could be used in the future researches focusing on adolescent mental health.
		                        		
		                        		
		                        		
		                        	
9.Risk factors for surgical site infection after emergency abdominal surgery: a multicenter cross-sectional study in China
Ze LI ; Junru GAO ; Li SONG ; Peige WANG ; Jian'an REN ; Xiuwen WU ; Suming LUO ; Qingjun ZENG ; Yanhong WENG ; Xinjian XU ; Qingzhong YUAN ; Jie ZHAO ; Nansheng LIAO ; Wei MAI ; Feng WANG ; Hui CAO ; Shichen WANG ; Gang HAN ; Daorong WANG ; Hao WANG ; Jun ZHANG ; Hao ZHANG ; Dongming ZHANG ; Weishun LIAO ; Wanwen ZHAO ; Wei LI ; Peng CUI ; Xin CHEN ; Haiyang ZHANG ; Tao YANG ; Lie WANG ; Yongshun GAO ; Jiang LI ; Jianjun WU ; Wei ZHOU ; Zejian LYU ; Jian FANG
Chinese Journal of Gastrointestinal Surgery 2020;23(11):1043-1050
		                        		
		                        			
		                        			Objective:Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence.Methods:Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS.Results:A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ 2=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ 2=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ 2=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ 2=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ 2=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ 2=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ 2=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions:For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.
		                        		
		                        		
		                        		
		                        	
10.Risk factors for surgical site infection after emergency abdominal surgery: a multicenter cross-sectional study in China
Ze LI ; Junru GAO ; Li SONG ; Peige WANG ; Jian'an REN ; Xiuwen WU ; Suming LUO ; Qingjun ZENG ; Yanhong WENG ; Xinjian XU ; Qingzhong YUAN ; Jie ZHAO ; Nansheng LIAO ; Wei MAI ; Feng WANG ; Hui CAO ; Shichen WANG ; Gang HAN ; Daorong WANG ; Hao WANG ; Jun ZHANG ; Hao ZHANG ; Dongming ZHANG ; Weishun LIAO ; Wanwen ZHAO ; Wei LI ; Peng CUI ; Xin CHEN ; Haiyang ZHANG ; Tao YANG ; Lie WANG ; Yongshun GAO ; Jiang LI ; Jianjun WU ; Wei ZHOU ; Zejian LYU ; Jian FANG
Chinese Journal of Gastrointestinal Surgery 2020;23(11):1043-1050
		                        		
		                        			
		                        			Objective:Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence.Methods:Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS.Results:A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ 2=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ 2=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ 2=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ 2=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ 2=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ 2=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ 2=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions:For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.
		                        		
		                        		
		                        		
		                        	
            

Result Analysis
Print
Save
E-mail