Home » Archive
Chinese Journal of Digestive SurgerySeptember 2018,Vol.17,No.9Original Articles

Predictive value of non-thyroidal illness syndrome before definitive operation on postoperative surgical site infection in patients with enterocutaneous fistula

Read More£º
¡¾Clicks£º26¡¿¡¾Download£º9¡¿
¡¾Abstract¡¿

Objective:To investigate the predictive value of non-thyroidal illness syndrome (NTIS) before definitive operation on postoperative surgical site infection (SSI) in patients with enterocutaneous fistula (ECF).
Methods:The retrospective case-control study was conducted. The clinical data of 264 ECF patients (181 with euthyroidism and 83 with NTIS) who underwent definitive operation in the Nanjing General Hospital of Nanjing Military Command between April 2014 and November 2016 were collected. After definitive operation, 86 with SSI and 178 without SSI were respectively allocated into the SSI group and non-SSI group. Observation indicators: (1) risk factor analysis of postoperative SSI; (2) effect of preoperative NTIS on postoperative SSI; (3) predictive power of serum free triiodothyronine 3 (FT3) level on postoperative SSI. Measurement data with normal distribution were represented as ±s and was analyzed using the t test. Count data were described as absolute number or percentage, and were analyzed using the chi-square test. The comparison of ordinal data was done by the nonparamentric test. The multivariate analysis was done using the logistic regression model. The receiver operating characteristic (ROC) curve was drawn, and area under the curve (AUC) was calculated for analyzing predictive power of serum FT3 level on postoperative SSI.
Results:(1) Risk factor analysis of postoperative SSI: cases with volume of preoperative intestinal fluid loss through fistula stoma < 200 mL/24 hours, from 200 to 500 mL/24 hours and > 500 mL/24 hours, preoperative hemoglobin (Hb) level, cases with surgical site located in stomach and duodenum, small intestine, ileocolon and colorectum, cases with open surgery and laparoscopic surgery were respectively 65, 15, 6, (119±36)g/L, 5, 50, 31, 36, 58, 28 in the SSI group and 135, 27, 16, (125±39)g/L, 11, 91, 53, 71, 127, 51 in the non-SSI group, with no statistically significant difference between groups (x2=0.471, t=1.202, x2=0.332, 0.422, P>0.05). Cases with preoperative single and multiple fistula stoma, serum albumin (Alb) level, cases with preoperative NTIS, volume of intraoperative blood loss < 300 mL and ≥ 300 mL, operation duration < 3 hours and ≥ 3 hours were respectively 57, 29, (35±8)g/L, 36, 67, 19, 53, 33 in the SSI group and 146, 32, (37±9)g/L, 47, 161, 17, 140, 38 in the non-SSI group, with statistically significant differences between groups (x2=8.089, t=2.422, x2=6.426, 7.746, 8.547, P<0.05). Results of multivariate analysis showed that preoperative multiple intestinal fistula and NTIS were independent factors affecting occurrence of postoperative SSI in ECF patients (odds ratio=1.873, 2.464, 95% confidence interval: 1.052-2.671, 1.120-4.392). (2) Effect of preoperative NTIS on postoperative SSI: incidence of preoperative multiple intestinal fistula, proportion of cases with preoperative enteral nutrition time > 3 months, incidence of postoperative SSI, postoperative superficial and deep incision infection rates and organ/space infection rate were respectively 31.3%(26/83), 72.3%(60/83), 43.4%(36/83), 9.6%(8/83), 21.7%(18/83), 7.2%(6/83) in patients with NTIS and 19.3%(35/181), 57.5%(104/181), 27.6% (50/181), 11.6%(21/181), 3.9%(7/181), 8.8%(16/181) in patients with euthyroidism, with statistically significant differences in incidence of multiple intestinal fistula, proportion of cases with preoperative enteral nutrition time > 3 months, incidence of postoperative SSI, superficial and deep incision infection rates (x2=4.603, 5.319, 6.426, 4.256, 4.377, P<0.05), and no statistically significant difference in organ/space infection rate (x2=0.193, P>0.05). (3) Predictive power of serum FT3 level on postoperative SSI: the ROC curve showed that optimal cut-off point of serum FT3 predicting postoperative SSI was 3.5 pmol/L, AUC, sensibility and specificity were respectively 0.75, 72.6% and 68.7%.
Conclusion:The presence of NTIS is associated with occurrence of postoperative SSI in patients with ECF before definitive operation, and optimal cut-off point of serum FT3 predicting postoperative SSI is 3.5 pmol/L.

Author£ºRen Huajian,Wang Gefei,Gu Guosheng,Hong Zhiwu,Chen Jun, Wu Xiuwen,Hu Qiongyuan, Ren Jian¡äan.
Work unit£ºResearch Institute of General Surgery of PLA, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China
DOI£º10.3760/cma.j.issn.1673-9752.2018.09.013

Directory

2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007

Journal Information

Responsible Information

China Association for Science and Technology

Sponsor

Chinese Medical Association

Editing

Editorial Board of Chinese Journal of Digestive Surgery
29 Gaotanyan, Shapingba, Chongqing 400038, China
Tel: 0086-23-68754655
Fax: 0086-23-65317637
Email: digsurg@zhxhwk.com

Editor-in-Chief

DONG Jia-hong

Managing Director

CHEN Min

Publishing

Chinese Medical Journals
Publishing House Co., Ltd.

Overseas Distributor

China International Book Trading Corportation

CSSN

ISSN 1673-9752
CN 11-5610/R