Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery - 15/11/18

Doi : 10.1016/j.jhin.2018.08.010

E. Shaw ^a,^b,^c,^⁎ , A. Gomila ^a,^b,^c, M. Piriz ^c,^d, R. Perez ^c,^e, J. Cuquet ^c,^f, A. Vazquez ^g, J.M. Badia ^c,^h,ⁱ, A. Lérida ^c,^j, D. Fraccalvieri ^c,^k, A. Marron ^c,^l, N. Freixas ^c,^m, A. Castro ^c,ⁿ, A. Cruz ^c,^o, E. Limón ^c,^p, F. Gudiol ^c,^p, S. Biondo ^c,^k, J. Carratalà ^a,^b,^c,^p, M. Pujol ^a,^b,^c
on behalf of
VINCat colon surgery group^¹
Members of the VINCat colon surgery group are listed in the Acknowledgements section.
D. Camprubí ^q, L. Martín ^r, C. Sanz ^r, M. Brugués ^s, X. Serra-Aracil ^t, L. Mora ^t, V. Diaz-Brito ^u, E. Moreno ^u, F. Obradors ^v, E. Espejo ^w, F. Aguilar ^w, L. Pagespetit ^w, C. Nicolás ^x, A. Navarro ^x, R. Vazquez ^y, N. Arroyo ^y, A.F. López ^z, S. Iftimie ^z
^q Hospital Bellvitge, Spain
^r Hospital de Viladecans, Spain
^s Consorci Sanitari de l'Anoia, Spain
^t Corporació Saniària Parc Taulí, Spain
^u Parc Sanitari Sant Joan de Déu de Sant Boi, Spain
^v Fundació Althaia, Spain
^w Consorci Sanitari de Terrassa, Spain
^x Hospital Universitari Mútua de Terrassa, Spain
^y Fundació Privada Hospital Asil de Granollers, Spain
^z Hospital Universitari Sant Joan de Reus, Spain

^a Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
^b Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
^c VINCat Programme, Barcelona, Spain
^d Infection Control, Corporació Sanitària Parc Taulí, Barcelona, Spain
^e Department of Internal Medicine, Fundació Althaia de Manresa, Barcelona, Spain
^f Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain
^g Servei d'Estadística Aplicada, Universitat Autònoma de Barcelona, Barcelona, Spain
^h Department of General Surgery, Hospital General de Granollers, Barcelona, Spain
ⁱ Universitat Internacional de Catalunya, Barcelona, Spain
^j Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain
^k Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
^l Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain
^m Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
ⁿ Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
^o Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain
^p University of Barcelona, Barcelona, Spain

^∗Corresponding author. Address: Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Feixa Llarga s/n. 08907 Hospitalet de Llobregat, Barcelona, Spain. Tel.: +34 932607274; fax: +34 932607637.Department of Infectious DiseasesHospital Universitari de Bellvitge-IDIBELLFeixa Llarga s/n. 08907 Hospitalet de LlobregatBarcelonaSpain

Summary

Background

Accounting for time-dependency and competing events are strongly recommended to estimate excess length of stay (LOS) and risk of death associated with healthcare-associated infections.

Aim

To assess the effect of organ/space (OS) surgical site infection (SSI) on excess LOS and in-hospital mortality in patients undergoing elective colorectal surgery (ECS).

Methods

A multicentre prospective adult cohort undergoing ECS, January 2012 to December 2014, at 10 Spanish hospitals was used. SSI was considered the time-varying exposure and defined as incisional (superficial and deep) or OS. Discharge alive and death were the study endpoints. The mean excess LOS was estimated using a multistate model which provided a weighted average based on the states patients passed through. Multivariate Cox regression models were used to assess the effect of OS-SSI on risk of discharge alive or in-hospital mortality.

Findings

Of 2778 patients, 343 (12.3%) developed SSI: 194 (7%) OS-SSI and 149 (5.3%) incisional SSI. Compared to incisional SSI or no infection, OS-SSI prolonged LOS by 4.2 days (95% confidence interval (CI): 4.1–4.3) and 9 days (8.9–9.1), respectively, reduced the risk of discharge alive (adjusted hazard ratio (aHR): 0.36 (95% CI: 0.28–0.47) and aHR: 0.17 (0.14–0.21), respectively), and increased the risk of in-hospital mortality (aHR: 8.02 (1.03–62.9) and aHR: 10.7 (3.7–30.9), respectively).

Conclusion

OS-SSI substantially extended LOS and increased risk of death in patients undergoing ECS. These results reinforce OS-SSI as the SSI with the highest health burden in ECS.

Le texte complet de cet article est disponible en PDF.

Keywords : Length of stay, Mortality, Surgical site infection, Organ-space infection, Elective colorectal surgery, Multistate modelling

Plan

Introduction

Methods

Setting and study design

Outcomes

Independent variables

Excess of length of stay

In-hospital mortality

Discussion

Export

Vol 100 - N° 4

P. 400-405 - décembre 2018 Retour au numéro

Article précédent

Timing, diagnosis, and treatment of surgical site infections after colonic surgery: prospective surveillance of 1263 patients
D. Martin, M. Hübner, E. Moulin, B. Pache, D. Clerc, D. Hahnloser, N. Demartines, F. Grass

| Article suivant

Nosocomial ventriculitis caused by a meticillin- and linezolid-resistant clone of Staphylococcus epidermidis in neurosurgical patients
C. Rodríguez-Lucas, J. Fernández, J.A. Boga, L. López-Amor, L. Forcelledo, E. Lázaro-López, M.R. Rodicio

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

connectez-vous ou créez un compte

Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery - 15/11/18

Summary

Background

Aim

Methods

Findings

Conclusion

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL