集束式干预措施预防腹股沟疝无张力修补术手术部位感染的随机对照研究
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摘要
目的探索集束式干预措施对于预防腹股沟疝修补术手术部位感染的效果。方法收集2016年12月至2017年10月,四川省人民医院125例腹股沟疝修补术手术患者,其中117例(93.6%)完成研究。采用随机对照试验,将腹股沟疝修补术患者按照随机数字表法分为干预组和对照组。干预组54例,实施集束式干预措施(术前洗必泰沐浴、电动备皮器备皮、手术当天备皮、使用洗必泰醇复方成分的皮肤消毒剂);对照组63例,采用常规措施。按照美国NHSN 2013年手术部位感染监测定义和监测方法,观察和比较2组患者的手术部位感染发生率和医疗成本消耗情况。结果干预组腹股沟疝修补术手术部位感染发生率3.70%(2/54),对照组12.70%(8/63),2组比较,差异无统计学意义(χ~2=1.969,P=0.161);干预组平均住院时间7(4~32)d,对照组8(3~45)d,2组比较,差异有统计学意义(Z=-1.995,P=0.046);干预组平均治疗总费用10 655.00(7 295.51~28 917.02)元,对照组11 737.96(7 953.61~24 103.04)元,2组比较,差异有统计学意义(Z=-2.433,P=0.015)。结论暂未观察到集束式干预措施可显著降低腹股沟疝修补术手术部位感染的发生率,其有效性有待进一步研究确认;但集束式干预措施可有效缩短腹股沟疝修补术患者平均住院时间和平均治疗费用,从而提高医疗资源利用率、医院的收入,降低医疗费用支出。
Objective To explore a bundled intervention(preoperative chlorhexidine bath,electric skin preparation,skin preparation on the day of surgery,skin disinfectant with chlorhexidine compound) for prevention surgical site infection(SSI) of inguinal hernia repair.Methods From December 2016 to October 2017,125 patients with inguinal hernia in Sichuan Provincial People's Hospital were enrolled.Of these,117(93.6%) completed the study.Patients with inguinal hernia repair were divided into intervention group and control group according to random number table method.54 patients in the intervention group were treated with the bundled intervention;63 patients in the control group were treated with conventional measures.The incidence of SSI and the medical cost of the two groups were observed and compared.Results The incidence of SSI was 3.70%(2/54) in the intervention group and 12.70%(8/63) in the control group.There was no significant difference between the two groups(χ2=1.969,P=0.161).The average hospital stay was 7 days(4 to 32 days) in the intervention group,and the control group was 8 days(3 to 45 days).The difference between the two groups was statistically significant(Z=-1.995,P=0.046).The average treatment cost of the intervention group was 10 655 yuan(7 295.51 to 28 917.02)yuan,the control group was 11 737.96 yuan(7 953.61 to 24 103.04)yuan,and the difference between the two groups was statistically significant(Z=-2.433,P=0.015).Conclusion The bundled intervention has not been observed to significantly reduce the incidence of SSI in inguinal hernia repair,and its effectiveness needs further study.However,the bundled intervention can effectively shorten the average length of hospital stay and average treatment cost for patients with inguinal hernia.
Objective To explore a bundled intervention(preoperative chlorhexidine bath,electric skin preparation,skin preparation on the day of surgery,skin disinfectant with chlorhexidine compound) for prevention surgical site infection(SSI) of inguinal hernia repair.Methods From December 2016 to October 2017,125 patients with inguinal hernia in Sichuan Provincial People's Hospital were enrolled.Of these,117(93.6%) completed the study.Patients with inguinal hernia repair were divided into intervention group and control group according to random number table method.54 patients in the intervention group were treated with the bundled intervention;63 patients in the control group were treated with conventional measures.The incidence of SSI and the medical cost of the two groups were observed and compared.Results The incidence of SSI was 3.70%(2/54) in the intervention group and 12.70%(8/63) in the control group.There was no significant difference between the two groups(χ2=1.969,P=0.161).The average hospital stay was 7 days(4 to 32 days) in the intervention group,and the control group was 8 days(3 to 45 days).The difference between the two groups was statistically significant(Z=-1.995,P=0.046).The average treatment cost of the intervention group was 10 655 yuan(7 295.51 to 28 917.02)yuan,the control group was 11 737.96 yuan(7 953.61 to 24 103.04)yuan,and the difference between the two groups was statistically significant(Z=-2.433,P=0.015).Conclusion The bundled intervention has not been observed to significantly reduce the incidence of SSI in inguinal hernia repair,and its effectiveness needs further study.However,the bundled intervention can effectively shorten the average length of hospital stay and average treatment cost for patients with inguinal hernia.
引文
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[13]Cobb WS,Carbonell AM,Kalbaugh CL,et al.Infection risk of open placement of intraperitoneal composite mesh[J].Am Surg,2009,75(9):762-768.
[14]Berríos-Torres SI,Umscheid CA,Bratzler DW,et al.Centers for disease control and prevention guideline for the prevention of surgical site infection,2017[J].Surgery,2017,152(8):784.
[15]Anderson DJ,Podgorny K,Berríos-Torres SI,et al.Strategies to prevent surgical site infections in acute care hospitals:2014 update,2014[J]Infect Control Hosp Epidemiol,2014,35 Suppl 2:S66-S88.
[2]World Health Organization.Report on the endemic burden of healthcare-associated infection worldwide[R].Switzerland:Geneva,2011.
[3]Pittet D.Burden of endemic healthcare-associated infection in Africa[J].Int J Infect Dis,2014,21(6):51.
[4]Tolino MJ,Tripoloni DE,Ratto R,et al.腹壁疝补片修补相关感染:病理学、治疗和结局[J].中国实用外科杂志,2010,30(12):1057-1062.
[5]李占武,杨国志,王利.成人腹股沟疝无张力修补术后切口感染分析[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(5):63-65.
[6]叶慧,宗志勇,吕晓菊.2017年版美国疾病预防控制中心手术部位感染预防指南解读[J].中国循证医学杂志,2017(7):745-750.
[7]Magill SS,Hellinger W,Cohen J,et al.Prevalence of healthcareasociated infections in acute care hospitals in Jacksonville,Florida.[J].Infect Control Hosp Epidemiol,2012,33(3):283-291.
[8]Burger J,Luijendijk RW,Hop W,et al.Long-term follow-up of a randomized control trial of suture versus mesh-repair of incisional hernia[J].Ann Surg,2004,240(4):578-585.
[9]Luijendijk RW,Hop W,Van Del Tol M,et al.A comparison of suture-repair with mesh-repair for incisional hernia[J].N Engl J Med,2000,343(6):392.
[10]Arnaud J,Eloy R,Adlo V M,et al.Critical evaluation of prosthetic materials in repair of abdominal wall hernias:new criteria of tolerance and resistance[J].Am J Surg,1977,133(3):338-345.
[11]Randomized clinical trial of suture repair,polypropylene mesh or autodermal hernioplasty for incisional hernia[J].Brit J Surg,2010,89(1):50-56.
[12]Stephenson BM.Complications of open groin hernia repairs[J].Surg Clin N Am,2003,83(5):1255-1278.
[13]Cobb WS,Carbonell AM,Kalbaugh CL,et al.Infection risk of open placement of intraperitoneal composite mesh[J].Am Surg,2009,75(9):762-768.
[14]Berríos-Torres SI,Umscheid CA,Bratzler DW,et al.Centers for disease control and prevention guideline for the prevention of surgical site infection,2017[J].Surgery,2017,152(8):784.
[15]Anderson DJ,Podgorny K,Berríos-Torres SI,et al.Strategies to prevent surgical site infections in acute care hospitals:2014 update,2014[J]Infect Control Hosp Epidemiol,2014,35 Suppl 2:S66-S88.