An Evaluation of Surgical Site Infections by Wound Classification System Using the ACS-NSQIP

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• 作者：Gezzer Ortega ; M.D. ; Daniel S. Rhee ; M.D. ; M.P.H. ; Dominic J. Papandria ; M.D. ; Jessica Yang ; B.S. ; Andrew M. Ibrahim ; B.A. ; Andrew D. Shore ; Ph.D. ; Martin A. Makary ; M.D. ; M.P.H. ; Fizan Abdullah ; M.D. ; Ph.D. ; ^fa@jhmi.edu
• 关键词：wound classification ; surgical site infection ; National Surgical Quality Improvement Program ; surgical outcomes
• 刊名：Journal of Surgical Research
• 出版年：2012
• 期刊代码：299_00224804
• 类别：med
• 出版时间：1 May, 2012
• 卷：174
• 期：1
• 页码：33-38
• 文件大小：90 K

摘要

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Background

Surgical wound classification has been the foundation for infectious risk assessment, perioperative protocol development, and surgical decision-making. The wound classification system categorizes all surgeries into: clean, clean/contaminated, contaminated, and dirty, with estimated postoperative rates of surgical site infection (SSI) being 1%-5%, 3%-11%, 10%-17%, and over 27%, respectively. The present study evaluates the associated rates of the SSI by wound classification using a large risk adjusted surgical patient database.

Methods

A cross-sectional study was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset between 2005 and 2008. All surgical cases that specified a wound class were included in our analysis. Patient demographics, hospital length of stay, preoperative risk factors, co-morbidities, and complication rates were compared across the different wound class categories. Surgical site infection rates for superficial, deep incisional, and organ/space infections were analyzed among the four wound classifications using multivariate logistic regression.

Results

A total of 634,426 cases were analyzed. From this sample, 49.7%were classified as clean, 35.0%clean/contaminated, 8.56%contaminated, and 6.7%dirty. When stratifying by wound classification, the clean, clean/contaminated, contaminated, and dirty wound classifications had superficial SSI rates of 1.76%, 3.94%, 4.75%, and 5.16%, respectively. The rates of deep incisional infections were 0.54%, 0.86%, 1.31%, and 2.1%. The rates for organ/space infection were 0.28%, 1.87%, 2.55%, and 4.54%.

Conclusion

Using ACS-NSQIP data, the present study demonstrates substantially lower rates of surgical site infections in the contaminated and dirty wound classifications than previously reported in the literature.