Risk Factors Of Healthcare Associated Infection After Radical Resection Of Advanced Digestive System Tumor

Background:Advanced tumor has become an increasingly serious global health problem.As the preferred treatment,surgical operations always cause a higher morbidity and mortality.Most of the current research focuses on the recurrence rate of tumor but pays little attention to postoperative complications.Healthcare associated infection(HAI)is a common and serious postoperative complication,which seriously affects patients’prognosis.At present,research about risk factors of HAI focuses on the single operation and analyzes the risk factors of superficial surgical site infection(SSSI).On the other hand,most of these risk factors are about patients’ condition and preoperative complications,which are difficult to be improved.Objective:To know the incidence and major types of HAI within 30 days after elective radical resection of advanced digestive system tumor in our medical center,investigate the risk factors of HAI and its major types and explore the relationship between postoperative HAI and different surgical sites,providing the guidance for stratified management of anesthesia.Methods:This study was a retrospective cohort study of patients undergoing elective radical resection of advanced digestive system tumor,based on three prospective studies(NCT02715076,NCT02756910,ChiCTR-IPR-17011099).The primary outcome was the occurrence of HAI within 30 days after the surgery.The secondary outcomes were unplanned reoperation,unplanned readmission and length of stay.Univariate and multivariate analysis were conducted on HAI and its major types,using logistic regression analysis method.Variables in multivariate analysis were selected according to the clinical experience,sample characteristics and sample size of this study,results of univariate analysis and previous research.Multicollinearity diagnosis was carried out to exclude related variables.Results:A total of 839 patients were included in this study,including 575 males(68.5%)and 264 females(31.5%),with an average age of 62.9±10.8 years.112 patients had HAI(13.3%)within 30 days after surgery.Surgical site infection(SSI)and pneumonia were the major types of HAI,accounting for 56.3%and 33.9%of the total incidence of HAI respectively,and organ/space SSI was the major type of SSI.There were 19 patients(2.3%)experienced unplanned reoperation and 13(1.5%)experienced unplanned readmission.The average length of stay was 14(12,19)days.Multivariate analysis of HAI showed that laparoscopic surgery(OR=1.828,95%CI:1.033-3.235,P=0.038),pancreatoduodenectomy(OR=1.975,95%CI:1.034-3.771,P=0.039)and intraoperative blood loss>500ml(OR=1.979,95%CI:1.121-3.495,P=0.019)were independent risk factors of HAI within 30 days after surgery,while hepatectomy was its protective factor(OR=0.434,95%CI:0.206-0.912,P=0.028).Further analysis found that there is no obvious difference in results when preoperative neoadjuvant chemotherapy and radiotherapy were removed,or pancreatoduodenectomy was replaced by central venous catheterization(including PICC),or intraoperative blood loss>500ml was replaced by intraoperative allogeneic red blood cells transfusion>2U.Diabetes or perioperative hyperglycemia,hypoalbuminemia and advanced age which were mentioned as the risk factors of HAI in previous research didn’t show the significant correlation with HAI in this study.In terms of the two major types of HAI,colorectal surgery(OR=4.555,95%CI:2.128-9.750,P<0.001),pancreatoduodenectomy(OR=3.817,95%CI:1.908-7.637,P<0.001),intraoperative blood loss>500ml(OR=2.081,95%CI:1.053-4.111,P=0.035)and length of anesthesia>4h(OR=2.290,95%CI:1.109-4.726,P=0.025)were independent risk factors of SSI within 30 days after surgery.Male(OR=5.175,95%CI:1.568-17.077,P=0.007)and esophagectomy(OR=2.443,95%CI:1.152-5.178,P=0.020)were independent risk factors of pneumonia within 30 days after the surgery.Age ≥65y(OR=1.894,95%CI:0.955-3.755,P=0.068)had a certain correlation with pneumonia within 30 days after surgery,though it didn’t show any significant correlation.Adding to preoperative neoadjuvant chemotherapy and radiotherapy,the results of SSI and pneumonia didn’t change obviously.Conclusions:The incidence of HAI within 30 days after elective radical resection of advanced digestive system tumor in our medical center is 13.3%.SSI and pneumonia were the major types of HAI and organ/space SSI was the major type of SSI.Laparoscopic surgery,pancreatoduodenectomy and intraoperative blood loss>500ml were independent risk factors of HAI within 30 days after surgery,while hepatectomy was its protective factor.Colorectal surgery,pancreatoduodenectomy,intraoperative blood loss>500ml and length of anesthesia>4h were independent risk factors of SSI within 30 days after surgery.Male and esophagectomy were independent risk factors of pneumonia within 30 days after surgery,and age ≥65y had a certain correlation with it.This study suggested that for colorectal surgery and pancreatoduodenectomy,we should pay more attention to intraoperative volume management and organ perfusion,reducing the incidence of postoperative SSI,especially organ/space SSI mainly.As for the esophagectomy,we should focus on perioperative respiratory management such as respiratory function training and intraoperative lung protection,reducing the incidence of postoperative pneumonia mainly.