| Objectives:To investigate the current status of hospital infection in patients undergoing pancreaticoduodenectomy and analyze the risk factors of nosocomial infection.Based on this,the study aimed to construct the nomogram model for predicting the risk of hospital infection after pancreaticoduodenectomy,which was convenient to screen the high risk patients of nosocomial infection as soon as possible and took effective prevention and response measures in time.At the same time,the study evaluated the economic burden caused by hospital infection,including the economic burden of patients and the economic burden of hospital,which further illustrated the important clinical meaning of preventing and controlling hospital infection in patients undergoing pancreaticoduodenectomy.In addition,the study might provide reference and basis for health administration department to distribute rationally medical resources.Methods:Patients undergoing pancreaticoduodenectomy of a tertiary hospital in Shandong Province from January 1,2019 to December 31,2021 were selected as the subjects of this study.Relevant research data were collected by using the self-designed questionnaire of nosocomial infection target monitoring in patients undergoing pancreaticoduodenectomy and nosocomial infection economic burden in patients undergoing pancreaticoduodenectomy.The subjects were randomly divided into modeling group and validation group in a 7:3 ratio.SPSS 26.0 and R 4.1.0 were used for data analysis.Variables with P<0.05 in univariate analysis of the modeling group were included in binary logistic regression analysis,so as to screen the risk factors of nosocomial infection.Based on this,the study constructed the nomogram model for predicting the risk of hospital infection after pancreaticoduodenectomy.The prediction model was verified internally(modeling group)and externally(validation group).The area under ROC curve(AUC),calibration curve(Hosmer-Lemeshow test),and clinical decision curve(DCA)were used to evaluate the discrimination,calibration and clinical validity of the model.In addition,1:1 propensity score matching method was used to balance confounding factors between groups and calculate the economic burden of patients with nosocomial infection.Marginal analysis method was used to calculate the economic burden of hospital infection on medical institutions.Results:1.A total of 528 pancreaticoduodenectomy patients were enrolled in this study,with an average age of 59.16±10.40 years,including 324 male patients and 204 female patients.In the modeling group of 370 patients,the mean age of patients was 58.65± 10.47 years.In the validation group of 158 patients,the mean age of patients was 60.36±10.16 years.2.In this study,there were 93 patients with nosocomial infection.The nosocomial infection rate was 17.61%,and the incidence of HAI cases was 20.26%.3.In this study,the most common type of nosocomial infection after pancreaticoduodenectomy was abdominal infection,with a constituent ratio of 60.22%,followed by multiple site infection(20.43%),pulmonary infection(9.68%),biliary tract infection(5.38%),surgical incision infection(3.23%)and bloodstream infection(1.08%).4.Among the nosocomial infection patients after pancreaticoduodenectomy,92 strains of pathogenic bacteria were cultured,including 65 Gram-negative bacteria(composition ratio,70.65%),24 Gram-positive bacteria(composition ratio,26.09%)and 3 Fungus strains(composition ratio,3.26%).The most common Gram-negative bacteria was Escherichia coli,and the most common Gram-positive bacteria was Excrement enterococcus.5.Binary logistic regression analysis showed that anastomotic fistula,perioperative blood transfusion,abdominal effusion,jaundice and abdominal catheter drainage>13 days were the risk factors of nosocomial infection after pancreaticoduodenectomy.According to the risk factors,the nomogram model for predicting the risk of hospital infection after pancreaticoduodenectomy was constructed.In the nomogram prediction model,the area under ROC curve of the modeling group and the validation group were 0.785 and 0.759,which indicated the model had good discrimination.The calibration curves of the two groups showed that the predicted value of nosocomial infection risk probability was in good agreement with the actual value(P=0.779,P=0.693),and the calibration degree was good.The clinical decision curve of the two groups showed that the model had good clinical effectiveness.6.The total cost of patients with nosocomial infection after pancreaticoduodenectomy was 129212.34 yuan/case,and the total cost of patients with non-infection was 107194.69 yuan/case.Therefore,the direct economic burden caused by hospital infection in patients undergoing pancreaticoduodenectomy was 22017.65 yuan/case.The prolonged hospitalization time of patients with nosocomial infection was 7.00 days per person,and the indirect economic burden was 2822.68 yuan/case.The economic burden of medical institutions caused by hospital infection was 200,700 yuan.Conclusions:The incidence of nosocomial infection after pancreaticoduodenectomy was high,which brought huge economic burden to patients and medical institutions.Therefore,the targeted monitoring of patients undergoing pancreaticoduodenectomy should be strengthened.In this study,anastomotic fistula,perioperative blood transfusion,abdominal effusion,jaundice,and abdominal catheter drainage>13 days were regarded as risk factors for nosocomial infection after pancreaticoduodenectomy.According to the above risk factors,relevant prevention and control measures for nosocomial infection should be taken.In the study,the nomogram prediction model had good discrimination,calibration and clinical effectiveness.The prediction model was convenient for clinical medical staff to identify high-risk population of nosocomial infection early and took effective intervention measures in time,in order to reduce the incidence of hospital infection. |
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