关键词: 手术部位感染, 危险因素, 预后列线图模型

Abstract: Objective To systematically investigate potential medical risk factors for surgical site infection (SSI) in patients undergoing general surgery and propose evidence-based preventive strategies.Methods This retrospective cohort study analyzed clinical data from 907 patients who underwent abdominal surgery at our institution between March 2021 and April 2022.Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for postoperative SSI.A nomogram prediction model was constructed using the rms package in R 4.4.1.The discriminative ability and accuracy of the model were evaluated by calculating the Cindex,area under the receiver operating characteristic curve (AUC),and calibration curves.Results The incidence of SSI following abdominal surgery was 4.85%.The results of univariate analysis showed that age,ASA score,diabetes mellitus,hypertension,preoperative albumin,type of surgery,surgical procedure,type of incision,use of high-frequency electrocautery at the incision,and duration of surgery were correlated with combined surgical site infections after abdominal surgery (all P<0.05).Multivariate analysis revealed that diabetes mellitus,hypoalbuminemia,emergency surgery,open surgery,use of high-frequency electrocautery at the incision site,and prolonged operative duration were independent risk factors for SSI (all P<0.05).Subgroup analyses showed that diabetes mellitus,preoperative albumin <35g/L,and electrocautery use at the incision site were independent risk factors for SSI in laparoscopic or robotic surgery (all P<0.05),while emergency surgery,electrocautery use,and operative duration >3 hours were independent risk factors in open surgery (all P<0.05).The nomogram model for predicting SSI demonstrated a Cindex of 0.886 (95%CI:0.841~0.932),with a calibration curve closely aligned to the 45° reference line and an AUC of 0.886,indicating robust discriminative power and accuracy.Conclusion To effectively reduce SSI incidence in abdominal surgery patients,preoperative correction of malnutrition (e.g.,hypoalbuminemia),prioritization of minimally invasive procedures,strict control of operative duration,and minimization of high-frequency electrocautery use at incision sites (particularly in cases of wound bleeding) are strongly recommended.

Key words: surgical site infection, risk factors, prognostic nomogram model