Factors Associated with Post-Operative Sepsis of Long-term Dialysis Patients

• Main Authors: Shu-Hwa Chang, 張淑華
• Other Authors: Ching-Wen Chien
• Format: Others
• Language: zh-TW
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/49180006463638342414

碩士 === 國立陽明大學 === 醫務管理研究所 === 100 === Background: Since 2004 until 2007, Taiwan has the world's highest end-stage renal disease incidence and prevalence of renal failure patients during the dialysis treatment, by the early local infection to severe systemic infection sepsis causing organ damage , which leads to an important cause of morbidity and death of dialysis patients. Domestic literature does not explore the impact of surgery-related postoperative sepsis dialysis patients. The purpose of this study is to understand the new onset long-term dialysis patients after surgery, the impact factors of postoperative sepsis year memory live the risk to explore and understand the interference factors, and provide relevant medical staff on long-term dialysis patients need to undergo surgery, the surgical management application reference up on the clinical quality of research to share. Methods: This study is the use of the 2003-2005 National Health Insurance Research Database to do a retrospective case-control study. We use the　logistic regression analysis to study the factors related to postoperative sepsis for the long-term dialysis new patients, use the Kaplan-Meier survival curves and Cox's proportional hazards model for postoperative sepsis survival analysis, and use the generalized linear model analysis of medical consumption. Results: Participants 1,008 new onset dialysis patients treated in NIH (mean follow-up, 2.5 years). This study is divided into six groups from surgical category in health care ICD-9-CM Procedures Surgical Treatment of the project code, with the initial long-term dialysis patients after surgery induced the postoperative sepsis, postoperative sepsis’s factors including age, multiple surgery, and complications interfere with long-term dialysis patients. The risks of postoperative sepsis in one year survival of Long-term dialysis patients are age, multiple surgery, surgery type, health status and the part of the complications. Especially surgery of the plumalary system have the highest postoperative sepsis (Odd's Ratio 9.02), the highest risk (Hazard Ratio 1.71) for one year survival, and the longest for length of stay in hospitalization. The highest rate in the comorbidities are diabetes mellitus, which occurred postoperative sepsis is also the most. And the other comorbidities such as congestive heart failure, gastrointestinal bleeding, dysrhythmia, and stroke / transient ischemic attack, dysrhythmia occurrence of postoperative sepsis and one year survival are significantly(P<0.05), but analysis of comorbidities with or without the comorbidity was no significant difference (P>0.05) in the consumption of medical hospitalization days. Discussion: This study showed that significantly related to postoperative sepsis and surgical category and interference factors and first year survival is also significantly related to risks, consistent with other studies. Limitations of this study is to use the national health insurance database, not a detailed analysis of patient clinical records, but had no effect on the results; this study is to provide care for these patients surgery assessment application in the prevention of severe postoperative sepsis.