The Role of Anesthetic Management in Surgical Site Infections After Pediatric Intestinal Surgery.
Adolescent
Anesthesia, General
/ adverse effects
Anesthetics, Inhalation
/ administration & dosage
Child
Child, Preschool
Digestive System Surgical Procedures
/ adverse effects
Dose-Response Relationship, Drug
Elective Surgical Procedures
/ adverse effects
Female
Humans
Incidence
Infant
Intestinal Diseases
/ surgery
Male
Retrospective Studies
Risk Assessment
/ statistics & numerical data
Risk Factors
Sevoflurane
/ administration & dosage
Surgical Wound Infection
/ epidemiology
Children
Intestinal surgery
Surgical site infection
Volatile anesthetic
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
18
05
2020
revised:
25
09
2020
accepted:
20
10
2020
pubmed:
24
11
2020
medline:
5
5
2021
entrez:
23
11
2020
Statut:
ppublish
Résumé
Although surgical site infections (SSIs) remain a significant health care issue, a limited number of studies have analyzed risk factors for SSIs in children, particularly the role of intraoperative anesthetic management. Pediatric patients are less likely to have major adult risk factors for SSIs such as smoking and diabetes. Thus children may be more suitable as a cohort for examining the role of intraoperative anesthetics in SSIs. We examined an association between SSI incidence and anesthetic management in children who underwent elective intestinal surgery in a single institution. We performed a retrospective study of 621 patients who underwent elective intestinal surgery under general anesthesia between January 2017 and September 2019, with primary outcome as the incidence of SSIs. We compared patients who were dichotomized in accordance with the median of the sevoflurane dose. We used propensity score (PS) pairwise matching of these patients to avoid selection biases. PS matching yielded 204 pairs of patients. We found that higher doses of sevoflurane were associated with a higher incidence of SSIs (9.8% versus 3.9%, P = 0.019). We adjusted for intraoperative factors that were not included in the PS adjustment factors, and multivariate regression analysis after PS matching showed compatible results (odds ratio: 2.58, 95% confidence interval: 1.11-6.04, P = 0.028). Higher doses of sevoflurane are associated with increased odds of SSIs after pediatric elective intestinal surgery. A randomized controlled study of volatile anesthetic-based versus intravenous anesthetic-based anesthesia will be needed to further determine the role of anesthetic drugs in SSI risk.
Sections du résumé
BACKGROUND
Although surgical site infections (SSIs) remain a significant health care issue, a limited number of studies have analyzed risk factors for SSIs in children, particularly the role of intraoperative anesthetic management. Pediatric patients are less likely to have major adult risk factors for SSIs such as smoking and diabetes. Thus children may be more suitable as a cohort for examining the role of intraoperative anesthetics in SSIs.
AIM
We examined an association between SSI incidence and anesthetic management in children who underwent elective intestinal surgery in a single institution.
METHODS
We performed a retrospective study of 621 patients who underwent elective intestinal surgery under general anesthesia between January 2017 and September 2019, with primary outcome as the incidence of SSIs. We compared patients who were dichotomized in accordance with the median of the sevoflurane dose. We used propensity score (PS) pairwise matching of these patients to avoid selection biases. PS matching yielded 204 pairs of patients.
RESULTS
We found that higher doses of sevoflurane were associated with a higher incidence of SSIs (9.8% versus 3.9%, P = 0.019). We adjusted for intraoperative factors that were not included in the PS adjustment factors, and multivariate regression analysis after PS matching showed compatible results (odds ratio: 2.58, 95% confidence interval: 1.11-6.04, P = 0.028).
CONCLUSIONS
Higher doses of sevoflurane are associated with increased odds of SSIs after pediatric elective intestinal surgery. A randomized controlled study of volatile anesthetic-based versus intravenous anesthetic-based anesthesia will be needed to further determine the role of anesthetic drugs in SSI risk.
Identifiants
pubmed: 33223141
pii: S0022-4804(20)30734-4
doi: 10.1016/j.jss.2020.10.015
pmc: PMC7897223
mid: NIHMS1642490
pii:
doi:
Substances chimiques
Anesthetics, Inhalation
0
Sevoflurane
38LVP0K73A
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
546-554Subventions
Organisme : NIGMS NIH HHS
ID : R01 GM127600
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Références
Lancet. 1993 Nov 27;342(8883):1328-33
pubmed: 7901637
Br J Anaesth. 2003 Aug;91(2):170-4
pubmed: 12878613
Anesthesiology. 2010 Aug;113(2):279-84
pubmed: 20657202
Am J Infect Control. 2018 Jun;46(6):602-609
pubmed: 29525367
J Anesth. 2004;18(3):203-9
pubmed: 15290420
Lancet Infect Dis. 2016 Dec;16(12):e288-e303
pubmed: 27816414
JAMA Netw Open. 2019 Oct 2;2(10):e1913570
pubmed: 31626316
Curr Opin Support Palliat Care. 2008 Mar;2(1):14-8
pubmed: 18685388
PLoS One. 2019 May 9;14(5):e0216163
pubmed: 31071106
Surg Endosc. 2010 Feb;24(2):270-6
pubmed: 19533235
Am J Infect Control. 2015 Jun;43(6):617-23
pubmed: 25818024
J Hosp Infect. 2010 Feb;74(2):129-36
pubmed: 20061057
Korean J Anesthesiol. 2016 Aug;69(4):332-40
pubmed: 27482309
Toxicol Sci. 2017 Apr 1;156(2):402-411
pubmed: 28003439
Anesth Analg. 2001 Oct;93(4):947-53
pubmed: 11574362
Anesth Analg. 2020 Aug;131(2):631-639
pubmed: 32149756
Rev Urol. 2009 Fall;11(4):190-5
pubmed: 20111631
N Engl J Med. 2014 Mar 27;370(13):1198-208
pubmed: 24670166
PLoS One. 2008 Apr 02;3(4):e1879
pubmed: 18382663
N Engl J Med. 2000 Jan 20;342(3):161-7
pubmed: 10639541
Anesth Analg. 2016 Aug;123(2):326-35
pubmed: 27308954
FASEB J. 2019 Dec;33(12):14528-14541
pubmed: 31675483
J Anesth. 2013 Apr;27(2):261-8
pubmed: 23096126
J Anesth. 2005;19(1):40-4
pubmed: 15674515
Anesth Analg. 1993 Feb;76(2):348-52
pubmed: 8424514
N Engl J Med. 1996 May 9;334(19):1209-15
pubmed: 8606715
Infect Control Hosp Epidemiol. 2018 Jan;39(1):1-11
pubmed: 29249216
J Surg Res. 2019 Jan;233:323-330
pubmed: 30502266
Lancet Infect Dis. 2016 Dec;16(12):e276-e287
pubmed: 27816413
J Am Coll Surg. 2010 Aug;211(2):232-8
pubmed: 20670861
Lancet. 2001 Sep 15;358(9285):876-80
pubmed: 11567703
JAMA Intern Med. 2013 Dec 9-23;173(22):2039-46
pubmed: 23999949
Anesthesiology. 1994 Apr;80(4):814-24
pubmed: 8024136
Anesthesiology. 1998 Nov;89(5):1125-32
pubmed: 9822000
Am J Infect Control. 2009 Jun;37(5):387-397
pubmed: 19398246
J Gastrointest Surg. 2017 Nov;21(11):1915-1930
pubmed: 28620749
J Anesth. 2008;22(3):263-77
pubmed: 18685933
Paediatr Anaesth. 2016 Jun;26(6):644-8
pubmed: 27091811
Am J Infect Control. 1999 Apr;27(2):97-132; quiz 133-4; discussion 96
pubmed: 10196487
Surg Today. 2008;38(5):404-12
pubmed: 18560962
PLoS One. 2013 Dec 18;8(12):e83743
pubmed: 24367612