背景:围手术期尿路感染(PUTI)在美国很常见,并且是高医疗保健成本的重要原因。缺乏关于全子宫切除术(TH)后PUTI危险因素的大量研究。
方法:我们使用2010年至2019年的全国住院患者样本(NIS)进行了一项回顾性研究,以分析与TH围手术期相关的PUTI的危险因素和年发生率。
结果:在9087名患者中发现了PUTIs,显示2.0%的发病率。不同年龄段的PUTI发生率存在显著差异(P<0.001)。在两组之间,保险类型一直存在显着差异,医院位置,病床尺寸,医院类型(P<0.001)。患有PUTIs的患者表现出明显更多的合并症(P<0.001)。毫不奇怪,PUTIs患者的中位住院时间更长(5天vs.2天;P<0.001)和更高的院内死亡率(从0.1到1.1%;P<0.001)。因此,总住院费用中位数增加了27,500美元(60,426美元与$32,926,P<0.001),因为PUTIs增加了医疗费用。PUTIs患者的择期住院较少见(66.8%与87.6%;P<0.001)。根据多变量逻辑回归研究,以下是TH后PUTIs的风险变量:45岁以上;合并症数量(≥1);医院床位大小(中等,大型);教学医院;医院区域(南部,西部);术前合并症(酗酒,缺乏性贫血,慢性失血性贫血,充血性心力衰竭,糖尿病,药物滥用,高血压,甲状腺功能减退,淋巴瘤液体和电解质紊乱,转移性癌症,其他神经系统疾病,瘫痪外周血管疾病,精神病患者,肺循环障碍,肾功能衰竭,实体瘤无转移,瓣膜疾病,体重减轻);和并发症(脓毒症,急性心肌梗死,深静脉血栓形成,消化道出血,肺炎,中风,伤口感染,伤口破裂,出血,肺栓塞,输血,术后谵妄)。
结论:研究结果表明,识别这些危险因素可以改善TH患者的PUTIs的预防策略和管理。应在手术前进行咨询,以减少PUTI的发生率。
■在医疗实践中,风险因素的识别可以改善患者的预防和治疗策略.我们使用2010年至2019年的全国住院患者样本(NIS)进行了一项回顾性研究,以分析与TH围手术期相关的PUTI的危险因素和年发生率。在9087名患者中发现了PUTI,显示2.0%的发病率。我们发现住院时间增加,医疗费用,先前存在的合并症的数量,医院的大小,教学医院,和地区也在UTI的风险中发挥作用。
■泌尿外科。
BACKGROUND: Perioperative urinary tract infections (PUTIs) are common in the United States and are a significant contributor to high healthcare costs. There is a lack of large studies on the risk factors for PUTIs after total hysterectomy (TH).
METHODS: We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively.
RESULTS: PUTIs were found in 9087 patients overall, showing a 2.0% incidence. There were substantial differences in the incidence of PUTIs based on age group (P < 0.001). Between the two groups, there was consistently a significant difference in the type of insurance, hospital location, hospital bed size, and hospital type (P < 0.001). Patients with PUTIs exhibited a significantly higher number of comorbidities (P < 0.001). Unsurprisingly, patients with PUTIs had a longer median length of stay (5 days vs. 2 days; P < 0.001) and a higher in-hospital death rate (from 0.1 to 1.1%; P < 0.001). Thus, the overall hospitalization expenditures increased by $27,500 in the median ($60,426 vs. $32,926, P < 0.001) as PUTIs increased medical costs. Elective hospitalizations are less common in patients with PUTIs (66.8% vs. 87.6%; P < 0.001). According to multivariate logistic regression study, the following were risk variables for PUTIs following TH: over 45 years old; number of comorbidities (≥ 1); bed size of hospital (medium, large); teaching hospital; region of hospital(south, west); preoperative comorbidities (alcohol abuse, deficiency anemia, chronic blood loss anemia, congestive heart failure, diabetes, drug abuse, hypertension, hypothyroidism, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, paralysis, peripheral vascular disorders, psychoses, pulmonary circulation disorders, renal failure, solid tumor without metastasis, valvular disease, weight loss); and complications (sepsis, acute myocardial infarction, deep vein thrombosis, gastrointestinal hemorrhage, pneumonia, stroke, wound infection, wound rupture, hemorrhage, pulmonary embolism, blood transfusion, postoperative delirium).
CONCLUSIONS: The findings suggest that identifying these risk factors can lead to improved preventive strategies and management of PUTIs in TH patients. Counseling should be done prior to surgery to reduce the incidence of PUTIs.
UNASSIGNED: In medical practice, the identification of risk factors can lead to improved patient prevention and treatment strategies. We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively. PUTIs were found in 9087 patients overall, showing a 2.0% incidence. We found that noted increased length of hospital stay, medical cost, number of pre-existing comorbidities, size of the hospital, teaching hospitals, and region to also a play a role in the risk of UTI\'s.
UNASSIGNED: Urogynecology.