| ObjectivesThis study aims to investigate and explore the current status and risk factors of hospital infection in patients with oral cancer surgery,and to construct Logistic regression and decision tree risk prediction model,so as to facilitate early screening of high-risk groups of hospital infection after oral cancer surgery.By evaluating the economic burden caused by hospital infection,including the direct and indirect economic burden of patients,we aim to provide relevant reference for the rational use of medical resources.MethodTotally 826 patients with oral cancer who underwent surgery in a certain grade A tertiary hospital in Shandong Province from January 1,2018 to December 31,2021 were collected in this study by cluster sampling method.The clinical data of patients were collected according to self-made ’Hospital Infection Target Monitoring Questionnaire for Patients with Oral Cancer Surgery’ and ’ Hospital Infection Economic Burden Questionnaire for Patients with Oral Cancer Surgery ’.Patients were randomly divided into model group(660 cases)and test group(166 cases)according to the ratio of 8:2.In the model group,the risk factors of hospital infection were screened by single factor analysis,and the factors with statistical significance P<0.05 were included in the multivariate logistic regression to establish the logistic regression prediction model.The fitting effect was tested by Hosmer-lemeshow,and the prediction effect was tested by area under curre(AUC)under the receiver operating characteristic(ROC)curve.Chi-squared automatic interaction detector(CHAID)was used to construct a decision tree prediction model(the minimum sample size of the parent node was 20,the child node was 10,and the maximum tree depth was 3).Risk statistics and AUC were used to evaluate the model.The external validation of the model was performed using the test group data,and AUC of Logistic model and decision tree model was compared by Z test.The propensity score weighting method was used to match according to the 1:1 propensity condition to explore the economic burden caused by nosocomial infection in patients with oral cancer surgery.Results1.A total of 826 patients with oral cancer surgery were included in this study,including 494 males(59.81%)and 332 females(40.19%).The average age was 58.90 ± 12.970 years old.All patients were divided randonmly into two groups:model group(n=660)and test group(n=166).Among model group,400 cases were males(60.61%)and 260 cases were females(39.39%),with an average age of 58.77 ± 12.984 years old.Among test group,94 cases were males(56.63%)and 72 cases were females(43.37%),with an average age of 59.43±12.938 years old.2.Among the 826 patients included in the study,129 cases of hospital infection occurred,with a total of 148 case-times,and the incidence of hospital infection was 15.62%and the incidence of hospital infection case-times was 17.92%.The incidence of hospital infection was 16.36%and the incidence of hospital infection case-times was 19.24%in model group.On the other hand the incidence of hospital infection was 12.65%and the incidence of hospital infection case-times was 13.25%in test group.3.Among 129 cases of postoperative infection of oral cancer,surgical incision infection was the most common in 74 cases(57.36%),including 63 cases(48.84%)of deep surgical incision infection,11 cases(8.53%)of superficial surgical incision infection,followed by 32 cases(24.81%)of pulmonary infection and 19 cases(14.73%)of multisite infection.In model group,there were 63 cases(58.33%)of surgical incision infection,including 55 cases(50.92%)of deep surgical incision infection and 8 cases of superficial surgical incision infection(7.41%),24 cases(22.22%)of pulmonary infection,and 18 cases(16.67%)of multi-site infection.In test group,there were 11 cases(52.38%)of surgical incision infection,including 3 cases(14.29%)of superficial surgical incision infection and 8 cases(38.09%)of deep surgical incision infection 3,8 cases(38.10%)of pulmonary infection and 1 case(4.76%)of multi-site infection.4.Among the 129 cases with hospital infection,101 strains of pathogens were detected,65 strains(64.36%)of Gram-negative bacteria,of which Acinetobacter baumannii(15.84%)was the most detected,followed by Pseudomonas aeruginosa(11.88%)and Klebsiella pneumoniae(9.91%).33 strains(32.67%)of Gram-positive bacteria were detected,of which Staphylococcus epidermidis(5.94%)detected the most,followed by Staphylococcus aureus(4.95%),Streptococcus pharyngitis(4.95%)and Streptococcus viridans(3.96%).Besides,2 strains(1.98%)of fungi were also detected.5.Logistic regression analysis showed that the five independent risk factors of hospital infection after oral cancer surgery included diabetes mellitus,venous thrombosis,tracheotomy,total hospitalization time and combined use of antibiotics and six explanatory variables screened by decision tree CHAID algorithm included combined use of antibiotics,venous thrombosis,first-class nursing days,diabetes,number of drainage tubes and total hospitalization time.Logistic regression and decision tree risk prediction models were constructed according to risk factors.The AUC of model group was 0.879 and 0.870 respectively,and AUC of test group was 0.817 and 0.826 respectively,indicating good discrimination between the two models.The AUC was compared between the two prediction models(P=0.3795,Z=0.879),and the difference was not statistically significant.6.After 1:1 propensity score matching,the total cost of hospitalization in the infection group was 84055.31 yuan per case,the total cost in the non-infection group was 72354.87 yuan per case,and the direct economic burden of patients caused by hospital infection was 11700.44 yuan per case.Among them,the burden caused by western medicine was the largest(4267.68 yuan),followed by health materials(3301.12 yuan)and treatment costs(945.75 yuan).Hospital infection prolonged the hospitalization time of oral cancer patients by 4.5 days per case,and the indirect economic burden was 2163.69 yuan.ConclusionsOral cancer patients have a high proportion of hospital-acquired infections after surgery,so the targeted monitoring of patients with oral cancer should be enhanced.Diabetes mellitus,venous thrombosis,tracheotomy,total hospital stay,antibiotic combination,number of primary care days,and number of drains(>2)are risk factors for hospital infection after oral cancer surgery,and effective and targeted hospital infection prevention and control measures should be implemented for the above risk factors.At the same time,hospital infection brings huge economic burden to patients,and prolongs the hospitalization time of patients with oral cancer surgery.In this study,Logistic regression and decision tree risk prediction models were constructed and the two models have good discrimination and accuracy,which are helpful for early screening and judging the high risk population of hospital infection after oral cancer surgery,and formulate reasonable and effective intervention strategies as soon as possible to reduce the incidence of nosocomial infection. |
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