Surgical reorganization during the COVID-19 pandemic and impact on case-mix and surgical site infections: A multicenter cohort study in Italy

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES Health Policy Pub Date : 2024-06-15 DOI:10.1016/j.healthpol.2024.105113

Costanza Vicentini , Elettra Ugliono , Heba Safwat Mhmoued Abdo Elhadidy , Giovanni Paladini , Alessandro Roberto Cornio , Federico Cussotto , Mario Morino , Carla Maria Zotti

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Abstract

Background

The coronavirus 2019 (COVID-19) pandemic led to major disruptions in surgical activity, particularly in the first year (2020). The objective of this study was to assess the impact of surgical reorganization on surgical outcomes in Northern Italy in 2020 and 2021.

Methods

A retrospective cohort study was conducted among 30 hospitals participating in the surveillance system for surgical site infections (SSIs). Abdominal surgery procedures performed between 2018 and 2021 were considered. Predicted SSI rates for 2020 and 2021 were estimated based on 2018–2019 data and compared with observed rates. Independent predictors for SSI were investigated using logistic regression, including procedure year.

Results

7605 procedures were included. Significant differences in case-mix were found comparing the three time periods. Observed SSI rates among all patients in 2020 were significantly lower than expected based on 2018–2019 SSI rates (p 0.0465). Patients undergoing procedures other than cancer surgery in 2020 had significantly lower odds for SSI (odds ratio, OR 0.52, 95 % confidence interval, CI 0.3–0.89, p 0.018) and patients undergoing surgery in 2021 had significantly higher odds for SSI (OR 1.49, 95 % CI 1.07–2.09, p 0.019) compared to 2018–2019.

Conclusions

Enhanced infection prevention and control (IPC) measures could explain the reduced SSI risk during the first pandemic year. IPC practices should continue to be reinforced beyond the pandemic context.

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COVID-19 大流行期间的外科重组及其对病例组合和手术部位感染的影响：意大利多中心队列研究

背景2019年冠状病毒（COVID-19）大流行导致外科手术活动严重中断，尤其是在第一年（2020年）。本研究旨在评估手术重组对 2020 年和 2021 年意大利北部手术结果的影响。方法在参与手术部位感染（SSI）监测系统的 30 家医院中开展了一项回顾性队列研究。研究对象为 2018 年至 2021 年期间实施的腹部手术。根据 2018-2019 年的数据估算了 2020 年和 2021 年的 SSI 感染率，并与观察到的感染率进行了比较。使用逻辑回归法（包括手术年份）调查了 SSI 的独立预测因素。三个时间段的病例组合存在显著差异。根据 2018-2019 年的 SSI 感染率，2020 年所有患者中观察到的 SSI 感染率明显低于预期（P 0.0465）。与 2018-2019 年相比，2020 年接受癌症手术以外的其他手术的患者发生 SSI 的几率明显较低（几率比，OR 0.52，95 % 置信区间，CI 0.3-0.89，p 0.018），而 2021 年接受手术的患者发生 SSI 的几率明显较高（OR 1.49，95 % 置信区间，CI 1.07-2.09，p 0.019）。大流行结束后应继续加强IPC措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.