Surgical Site Infection in a Tertiary Neonatal Surgery Centre.

Autor: Woldemicael AY; Department of Pediatric Surgery, St George's University Hospitals NHS Foundation Trust, London, United Kingdom., Bradley S; Department of Neonatal Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom., Pardy C; Department of Pediatric Surgery, St George's University Hospitals NHS Foundation Trust, London, United Kingdom., Richards J; Department of Neonatal Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom., Trerotoli P; Department of Biological Sciences and Human Oncology, University of Bari, Bari, Italy., Giuliani S; Department of Pediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Jazyk: angličtina
Zdroj: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie [Eur J Pediatr Surg] 2019 Jun; Vol. 29 (3), pp. 260-265. Date of Electronic Publication: 2018 Mar 26.
DOI: 10.1055/s-0038-1636916
Abstrakt: Introduction:  Surgical site infection (SSI) is a key performance indicator to assess the quality of surgical care. Incidence and risk factors for SSI in neonatal surgery are lacking in the literature.
Aim:  To define the incidence of SSI and possible risk factors in a tertiary neonatal surgery centre.
Materials and Methods:  This is a prospective cohort study of all the neonates who underwent abdominal and thoracic surgery between March 2012 and October 2016. The variables analyzed were gender, gestational age, birth weight, age at surgery, preoperative stay in neonatal intensive care unit, type of surgery, length of stay, and microorganisms isolated from the wounds. Statistical analysis was done with chi-square, Student's t - or Mann-Whitney U -tests. A logistic regression model was used to evaluate determinants of risk for SSI; variables were analyzed both with univariate and multivariate models. For the length of hospital stay, a logistic regression model was performed with independent variables.
Results:  A total of 244 neonates underwent 319 surgical procedures. The overall incidence of SSIs was 43/319 (13.5%). The only statistical differences between neonates with and without SSI were preoperative stay (<4 days vs. ≥4 days, p  < 0.01) and length of hospital stay (<30 days vs. ≥30 days, p  < 0.01). A pre-operative stay longer than 4 days was associated with almost three times increased risk of SSI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.05-8.34, p  = 0.0407). Gastrointestinal procedures were associated with more than ten times the risk of SSI compared with other procedures (OR 10.17, 95% CI 3.82-27.10, p  < 0.0001). Gastroschisis closure and necrotizing enterocolitis (NEC) laparotomies had the highest incidence SSI (54% and 62%, respectively). The risk of longer length of hospital stay after SSI was more than three times higher (OR = 3.36, 95%CI 1.63-6.94, p  = 0.001).
Conclusion:  This is the first article benchmarking the incidence of SSI in neonatal surgery in the United Kingdom. A preoperative stay ≥4 days and gastrointestinal procedures were independent risk factors for SSI. More research is needed to develop strategies to reduce SSI in selected neonatal procedures.
Competing Interests: None.
(Georg Thieme Verlag KG Stuttgart · New York.)
Databáze: MEDLINE
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