The risk factors of hospital-acquired pneumonia after neurosurgical operations

doi:10.3877/cma.j.issn.1674-1358.2016.01.011

Abstract

Abstract:

Objective

To investigate the risk factors of hospital acquired pneumonia (HAP) after neurosurgical operations, and to provide theoretical basis for the formulate of hospital-related control measures.

Methods

The clinical data of 533 patients with neurosurgical operations were analyzed by multivariate Logistic regression analysis and χ² test, while the risk factors of HAP were detected.

Results

Among the 533 cases, 89 (16.70%) cases were with HAP. The results of processing χ² test showed that 11 factors had significant difference (P all < 0.05), including the age, surgery type, anesthesia type, operative time, loss of blood intraoperative, ASA score, implants, use of antimicrobial drugs, preoperative, postoperative and overall hospitalization period. The multivariate Logistic regression analysis showed that the age (OR = 4.08, 95%CI: 2.18-7.65), ASA score (OR = 4.44, 95%CI: 2.06-9.59) and overall hospitalization days (OR = 2.90, 95%CI: 1.21-6.97) were independent risk factors of HAP, respectively. While elective surgery (OR = 0.54, 95%CI: 0.30-0.97) and using antimicrobial drugs (OR = 0.31, 95%CI: 0.12-0.79) were independent protective factors.

Conclusions

Effective prevention of the risk factors was the key to control the hospital acquired pneumonia.

Key words: Neurosurgy, Operation patients, Hospital acquired pneumonia, Risk factors

Guiming Wang, Shuxiang Niu, Kaigang Zhang, Meijie Jiang, Ling Zhang, Ronghui Zhai. The risk factors of hospital-acquired pneumonia after neurosurgical operations[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2016, 10(01): 49-53.

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References 16

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影响因素		非感染组（444例）	感染组（89例）	感染率（%）	χ²值	P值
性别
	男	272	59	17.82	0.797	0.372
	女	172	30	14.85
年龄（岁）
	< 55	230	22	8.73	21.816	< 0.001^a
	≥ 55	214	67	23.84
手术类型
	急诊	91	46	33.58	37.767	< 0.001^a
	择期	353	43	10.86
麻醉类型
	全身麻醉	274	44	13.84	4.641	0.031^a
	非全身麻醉	170	45	20.93
手术时间（min）
	< 240	311	74	19.22	6.344	0.012^a
	≥ 240	133	15	10.14
术中失血量（ml）
	< 300	336	57	14.50	5.178	0.023^a
	≥ 300	108	32	22.86
ASA评分
	Ⅰ、Ⅱ	244	10	3.94	56.807	< 0.001^a
	Ⅲ、Ⅳ、Ⅴ	200	79	28.32
切口等级
	Ⅰ	423	88	17.22	2.436	0.119
	Ⅱ、Ⅲ	21	1	4.55
植入物
	无	353	83	19.04	9.421	0.002^a
	有	91	6	6.19
应用抗菌药物
	否	21	14	40.00	14.623	< 0.001^a
	是	423	75	15.06
术前住院天数（d）
	< 5	308	82	21.03	19.573	< 0.001^a
	≥ 5	136	7	4.90
术后住院天数（d）
	< 14	239	11	4.40	51.195	< 0.001^a
	≥ 14	205	78	27.56
全部住院天数（d）
	< 18	244	17	6.51	38.138	< 0.001^a
	≥ 18	200	72	26.47

影响因素		非感染组（444例）	感染组（89例）	感染率（%）	χ²值	P值
性别
	男	272	59	17.82	0.797	0.372
	女	172	30	14.85
年龄（岁）
	< 55	230	22	8.73	21.816	< 0.001^a
	≥ 55	214	67	23.84
手术类型
	急诊	91	46	33.58	37.767	< 0.001^a
	择期	353	43	10.86
麻醉类型
	全身麻醉	274	44	13.84	4.641	0.031^a
	非全身麻醉	170	45	20.93
手术时间（min）
	< 240	311	74	19.22	6.344	0.012^a
	≥ 240	133	15	10.14
术中失血量（ml）
	< 300	336	57	14.50	5.178	0.023^a
	≥ 300	108	32	22.86
ASA评分
	Ⅰ、Ⅱ	244	10	3.94	56.807	< 0.001^a
	Ⅲ、Ⅳ、Ⅴ	200	79	28.32
切口等级
	Ⅰ	423	88	17.22	2.436	0.119
	Ⅱ、Ⅲ	21	1	4.55
植入物
	无	353	83	19.04	9.421	0.002^a
	有	91	6	6.19
应用抗菌药物
	否	21	14	40.00	14.623	< 0.001^a
	是	423	75	15.06
术前住院天数（d）
	< 5	308	82	21.03	19.573	< 0.001^a
	≥ 5	136	7	4.90
术后住院天数（d）
	< 14	239	11	4.40	51.195	< 0.001^a
	≥ 14	205	78	27.56
全部住院天数（d）
	< 18	244	17	6.51	38.138	< 0.001^a
	≥ 18	200	72	26.47

变量	变量名	赋值
年龄	X₁	< 55岁= 1	≥ 55岁= 2
手术类型	X₂	急诊= 1	择期= 2
麻醉类型	X₃	全身麻醉= 1	非全身麻醉= 2
手术时间	X₄	< 240 min = 1	≥ 240 min = 2
术中失血量	X₅	< 300 ml = 1	≥ 300 ml = 2
ASA评分	X₆	Ⅰ、Ⅱ = 1	Ⅲ、Ⅳ、Ⅴ = 2
植入物	X₇	无= 0	有= 1
应用抗菌药物	X₈	否= 0	是= 1
术前住院天数	X₉	< 5 d = 1	≥ 5 d = 2
术后住院天数	X₁₀	< 14 d = 1	≥ 14 d = 2
全部住院天数	X₁₁	< 18 d = 1	≥ 18 d = 2

变量	变量名	赋值
年龄	X₁	< 55岁= 1	≥ 55岁= 2
手术类型	X₂	急诊= 1	择期= 2
麻醉类型	X₃	全身麻醉= 1	非全身麻醉= 2
手术时间	X₄	< 240 min = 1	≥ 240 min = 2
术中失血量	X₅	< 300 ml = 1	≥ 300 ml = 2
ASA评分	X₆	Ⅰ、Ⅱ = 1	Ⅲ、Ⅳ、Ⅴ = 2
植入物	X₇	无= 0	有= 1
应用抗菌药物	X₈	否= 0	是= 1
术前住院天数	X₉	< 5 d = 1	≥ 5 d = 2
术后住院天数	X₁₀	< 14 d = 1	≥ 14 d = 2
全部住院天数	X₁₁	< 18 d = 1	≥ 18 d = 2

变量	B	S.E.	P值	OR值	95%CI
变量	B	S.E.	P值	OR值	LCI	HCI
年龄	1.406	0.32	< 0.001	4.08	2.18	7.65
手术类型	-0.617	0.30	0.040	0.54	0.30	0.97
麻醉类型	-0.215	0.443	0.628	0.81	0.34	1.92
手术时间	-0.38	0.438	0.386	0.68	0.29	1.61
术中失血量	0.823	0.438	0.060	2.28	0.97	5.38
ASA评分	1.490	0.393	< 0.001	4.44	2.06	9.59
植入物	-0.693	0.546	0.204	0.50	0.17	1.46
应用抗菌药物	-1.171	0.474	0.013	0.31	0.12	0.79
术前住院天数	-0.905	0.492	0.066	0.41	0.15	1.06
术后住院天数	0.726	0.506	0.151	2.07	0.77	5.58
全部住院天数	1.065	0.447	0.017	2.90	1.21	6.97

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