- 作者：Teena Chopra ; MD ; MPH ; tchopra@med.wayne.edu ; Dror Marchaim ; MD ; Ylinne Lynch ; BS ; Chris Kosmidis ; MD ; Jing J. Zhao ; PharmD ; Sorabh Dhar ; MD ; Naasha Gheyara ; MD ; Deborah Turner ; BS ; Don Gulish ; Michael Wood ; MD ; FACS ; George Alangaden ; MD ; Keith S. Kaye ; MD ; MPH
- 关键词：Roux-en-Y gastric bypass surgery ; Obesity ; Risk adjusted score
- 刊名：American Journal of Infection Control
- 出版年：2012
- 出版时间：November, 2012
- 年：2012
- 卷：40
- 期：9
- 页码：815-819
- 全文大小：177 K
Background
Surgical site infection (SSI) is a frequent problem complicating bariatric surgery. However, the potential risk factors, risk stratification, and outcomes of SSIs in this patient population remain poorly defined. The aim of this prospective case-control study was to characterize better the risk factors and to improve risk stratification for SSIs following bariatric surgery.Methods
Patients studied had SSI following Roux-en-Y gastric bypass surgery (RYGBS) between November 2006 and March 2009 at Harper University Hospital and were each matched with 3 controls based on type of operative procedure, surgeon, and year of surgery. Thirty-day outcomes included mortality, hospital readmissions, outpatient procedures, and emergency room visits. A scoring system (BULCS score) was compared with the National Nosocomial Infections Surveillance system risk index using logistic regression.
Results
In multivariate analysis, duration of surgery (odds ratio [OR], 3.3; 95 % confidence interval [CI]: 1.62-6.74), diagnosis of bipolar disorder (OR, 3.341; 95 % CI: 1.0-12.27), use of prophylactic antibiotics other than cefazolin (OR, 4.2; 95 % CI: 1.47-11.69), and sleep apnea (OR, 1.8; 95 % CI: 1.05-2.97) were significantly associated with SSI. Patients with SSI were more likely to have return emergency visits (OR, 4.96; 95 % CI: 2.9-8.48), readmission (OR, 6.53; 95 % CI: 3.44-12.42), and outpatient procedures following surgery (OR, 4.75; 95 % CI: 1.32-17.14) than were controls without SSI. The BULCS score was a stronger predictor of SSI than the National Nosocomial Infections Surveillance system (C-statistic,??0.62 vs 0.55, respectively).
Conclusion
SSI following bariatric surgery was associated with receipt of antibiotic prophylaxis other than cefazolin and comorbid conditions including sleep apnea and bipolar disorder. The BULCS score performed favorably as a predictor and risk adjuster for SSI following bariatric surgery. SSI was associated with increased health care resource utilization.