Wang Deyong,Jiang Li,Li Congjun,et al.Risk factors of wound infection after laparoscopic acute appendicitis in children and potency of a nomogram prediction model[J].Journal of Clinical Pediatric Surgery,,21():769-773.[doi:10.3760/cma.j.cn101785-202108066-012]
Risk factors of wound infection after laparoscopic acute appendicitis in children and potency of a nomogram prediction model
- Keywords:
- Appendicitis/PP; Laparoscopy; Surgical Wound Infection/CO; Surgical Wound Infection/ET; Risk Factors; Forecasting; Child
- Abstract:
- Objective To explore the risk factors of wound infection after laparoscopic acute appendicitis (AA) in children,construct a nomogram model to predict postoperative incision infection and evaluate the distinction and consistency of the model.Methods From January 2016 to March 2021,480 children undergoing appendectomy were selected as study subjects.They were assigned into two groups of surgical incision infection post-operation (n=65) and surgical incision non-infection post-operation (n=415).The relevant clinical data were collected.Single factor and multivariate Logistic regression analyses were employed for screening the risk factors of influencing wound infection.R software was utilized for constructing a nomogram model to predict postoperative incision infection and receiver operating characteristic (ROC) and calibration curves for verifying the discrimination and consistency of nomogram model.Results The incidence of wound infection was 13.54%(65/480).Univariate analysis indicated that age,course of disease,operative duration,preoperative fever,appendiceal perforation and indwelling abdominal drainage were all influencing factors of wound infection (P<0.05);multivariate Logistic regression analysis revealed that disease course >24h,operative duration >60 min,appendiceal perforation and indwelling abdominal drainage were the risk factors for incision infection;nomogram prediction model offered excellent discrimination (area under the ROC curve was 0.816,95%CI=0.716-0.871) and consistency (Hosmer-Lemeshow goodness of fit test showed=8.661,P=0.372).Conclusion With excellent discrimination and consistency,the above nomogram model may predict the risk of wound infection after laparoscopic AA in children.
References:
[1] Duman L,Cesur?,Kumbul Do?u? D,et al.Diagnostic value of serum pentraxin 3 level in children with acute appendicitis[J].Ulus Travma Acil Cerrahi Derg,2020,26(5):699-704.DOI:10.14744/tjtes.2020.23258.
[2] 冯伟,崔华雷,赵旭峰,等.儿童急性阑尾炎术后粘连性肠梗阻的影响因素分析[J].临床小儿外科杂志,2021,20(3):253-256,262.DOI:10.12260/lcxewkzz.2021.03.010. Feng W,Cui HL,Zhao XF,et al.Influencing factors of postoperative adhesive ileus in children with acute appendicitis[J].J Clin Ped Sur,2021,20(3):253-256,262.DOI:10.12260/lcxewkzz.2021.03.010.
[3] 朱旭光,周丽霞,段春胜,等.急性化脓性阑尾炎患儿术后切口感染的临床特点及相关因素分析[J].中华医院感染学杂志,2018,28(17):2686-2688.DOI:10.11816/cn.ni.2018-173375. Zhu XG,Zhou LX,Duan CS,et al.Clinical characteristics and related factors of postoperative incision infections in children with acute suppurative appendicitis[J].Chinese Journal of Nosocomiology,2018,28(17):2686-2688.DOI:10.11816/cn.ni.2018-173375.
[4] 李杰,刘铭.小儿急性阑尾炎术后切口感染影响因素及病原学分析[J].中国煤炭工业医学杂志,2020,23(2):213-216.DOI:10.11723/mtgyyx1007-9564202002022. Li J,Liu M.Influencing factors and etiological analysis of postoperative incision infection in pediatric acute appendicitis[J].Chinese Journal of Coal Industry Medicine,2020,23(2):213-216.DOI:10.11723/mtgyyx1007-9564202002022.
[5] Portinari M,Scagliarini M,Valpiani G,et al.Do i need to operate on that in the middle of the night?development of a nomogram for the diagnosis of severe acute cholecystitis[J].J Gastrointest Surg,2018,22(6):1016-1025.DOI:10.1007/s11605-018-3708-y.
[6] 尚红,王毓三,申子瑜.全国临床检验操作规程[M].第4版.北京:人民卫生出版社,2015:648-780. Shang H,Wang YS,Shen ZY.National clinical laboratory operating procedures[M].4th Edition.Beijing:People’s Health Publishing House,2015:648-780.
[7] 张林,张聪,李勇,等.白介素-6、降钙素原及C-反应蛋白对儿童急性阑尾炎伴穿孔的预测价值研究[J].临床小儿外科杂志,2021,20(8):749-753.DOI:10.12260/lcxewkzz.2021.08.009. Zhang L,Zhang C,Li Y,et al.Predictive values of interleukin-6,procalcitonin and C-reactive protein in acute appendicitis with perforation in children[J].J Clin Ped Sur,2021,20(8):749-753.DOI:10.12260/lcxewkzz.2021.08.009.
[8] Hsu YJ,Fu YW,Chin T.Seasonal variations in the occurrence of acute appendicitis and their relationship with the presence of fecaliths in children[J].BMC Pediatr,2019,19(1):443-448.DOI:10.1186/s12887-019-1824-9.
[9] Zhang Y,Lyu FX,Kang Q,et al.Association of meteorological factors with pediatric acute appendicitis in China:A 7-year retrospective analysis[J].Medicine (Baltimore),2018,97(42):1-7.DOI:10.1097/MD.0000000000012913.
[10] 李苗苗,崔华雷.小儿急性阑尾炎的诊疗进展[J].临床小儿外科杂志,2018,17(6):474-478.DOI:10.3969/j.issn.1671-6353.2018.06.017. Li MM,Cui HL.Advances in clinical diagnosis and treatment of acute appendicitis in children[J].J Clin Ped Sur,2018,17(6):474-478.DOI:10.3969/j.issn.1671-6353.2018.06.017.
[11] 苗家园,刘强,张成虎,等.儿童急性阑尾炎急诊手术切口感染发生危险因素研究[J].临床军医杂志,2021,49(12):1375-1377,1382.DOI:10.16680/j.1671-3826.2021.12.26. Miao JY,Liu Q,Zhang CH,et al.Risk factors for incision infection in children with acute appendicitis in emergency surgery[J].Clinical Journal of Medical Officer,2021,49(12):1375-1377,1382.DOI:10.16680/j.1671-3826.2021.12.26.
[12] 朱奎阳,陈刚,汤远银,等.腹腔镜与开腹手术治疗急性阑尾炎术后切口感染的危险因素分析[J].医学临床研究,2019,36(9):1805-1807.DOI:10.3969/j.issn.1671-7171.2019.09.050. Zhu KY,Chen G,Tang YY,et al.Risk factors of incision infection after laparoscopic and open surgery for acute appendicitis[J].Journal of Clinical Research,2019,36(9):1805-1807.DOI:10.3969/j.issn.1671-7171.2019.09.050.
[13] 谢朝云,蒙桂鸾,熊芸,等.化脓性阑尾炎急性穿孔患者手术部位感染相关因素分析[J].西北国防医学杂志,2019,40(2):77-82.DOI:10.16021/j.cnki.1007-8622.2019.02.003. Xie CY,Meng GL,Xiong Y,et al.Analysis of related factors of surgical site infection in patients with acute perforation of suppurative appendicitis[J].Medical Journal of National Defending Forces in Northwest China,2019,40(2):77-82.DOI:10.16021/j.cnki.1007-8622.2019.02.003.
[14] Serres SK,Cameron DB,Glass CC,et al.Time to appendectomy and risk of complicated appendicitis and adverse outcomes in children[J].JAMA Pediatr,2017,171(8):740-746.DOI:10.1001/jamapediatrics.2017.0885.
[15] Güler Y,Karabulut Z,?ali? H,et al.Comparison of laparoscopic and open appendectomy on wound infection and healing in complicated appendicitis[J].Int Wound J,2020,17(4):957-965.DOI:10.1111/iwj.13347.
[16] Li L,Ding J,Han J,et al.A nomogram prediction of postoperative surgical site infections in patients with perihilar cholangiocarcinoma[J].Medicine (Baltimore),2017,96(25):1-7.DOI:10.1097/MD.0000000000007198.
Memo
收稿日期:2021-8-27。
基金项目:2021年亳州市重点研发计划(bzzc2021024);2020年亳州市人民医院院级科研项目(By202029)
通讯作者:罗贤茂,Email:heynumber007@163.com