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[PMID]: | 28470562 |
[Au] Autor: | Cima RR; Bergquist JR; Hanson KT; Thiels CA; Habermann EB |
[Ad] Endereço: | Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. cima.robert@mayo.edu. |
[Ti] Título: | Outcomes are Local: Patient, Disease, and Procedure-Specific Risk Factors for Colorectal Surgical Site Infections from a Single Institution. |
[So] Source: | J Gastrointest Surg;21(7):1142-1152, 2017 Jul. | [Is] ISSN: | 1873-4626 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | BACKGROUND: Colorectal surgical site infections (SSIs) contribute to postoperative morbidity, mortality, and resource utilization. Risk factors associated with colorectal SSI are well-documented. However, quality improvement efforts are informed by national data, which may not identify institution-specific risk factors. METHOD: Retrospective cohort study of colorectal surgery patients uses institutional ACS-NSQIP data from 2006 through 2014. ACS-NSQIP data were enhanced with additional variables from medical records. Multivariable logistic regression identified factors associated with SSI development. RESULTS: Of 2376 patients, 213 (9.0%) developed at least one SSI (superficial 4.8%, deep 1.1%, organ space 3.5%). Age < 40, BMI > 30, ASA3+, steroid use, smoking, diabetes, pre-operative sepsis, higher wound class, elevated WBC or serum glutamic-oxalocetic transaminase, low hematocrit or albumin, Crohn's disease, and prolonged incision-to-closure time were associated with increased SSI rate (all P < 0.01). After adjustment, BMI > 30, steroids, diabetes, and wound contamination were associated with SSI. Patients with Crohn's had greater odds of SSI than other indications. CONCLUSION: Institutional modeling of SSI suggests that many previously suggested risk factors established on a national level do not contribute to SSIs at our institution. Identification of institution-specific predictors of SSI, rather than relying upon conclusions derived from external data, is a critical endeavor in facilitating quality improvement and maximizing value of quality investments. |
[Mh] Termos MeSH primário: |
Doenças do Colo/cirurgia Doenças Retais/cirurgia Infecção da Ferida Cirúrgica/etiologia
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[Mh] Termos MeSH secundário: |
Adulto Idoso Feminino Seres Humanos Modelos Logísticos Masculino Meia-Idade Melhoria de Qualidade Estudos Retrospectivos Fatores de Risco Resultado do Tratamento
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[Pt] Tipo de publicação: | JOURNAL ARTICLE |
[Em] Mês de entrada: | 1803 |
[Cu] Atualização por classe: | 180305 |
[Lr] Data última revisão:
| 180305 |
[Sb] Subgrupo de revista: | IM |
[Da] Data de entrada para processamento: | 170505 |
[St] Status: | MEDLINE |
[do] DOI: | 10.1007/s11605-017-3430-1 |
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