整形美容专业假体植入术后早期手术部位感染现状调查及质控改进成效分析

Current Status of Early Surgical Site Infection Following Prosthetic Implantation in Aesthetic and Reconstructive Surgery and Evaluation of Quality Control Improvement Outcomes

  • 摘要: 目的 评估我国4个省级行政区整形美容专业假体植入术后早期手术部位感染的现状,并探讨感染防控规范化操作培训的成效。方法 2025年1—5月,采用线上问卷调查的方式对重庆市、陕西省、江西省及贵州省开展整形美容假体植入手术的医疗机构进行基线调查,收集各类假体植入手术量及对应的早期手术部位感染发生情况。由国家整形美容专业医疗质量控制中心联合国家医院感染管理医疗质量控制中心共同制定假体植入术后早期手术部位感染防控改进策略,并组织推广与培训。随后,收集上述地区2025年6—10月的改进阶段数据,并对各地区及不同手术类别进行改进前后比较。结果 基线期共纳入209家医疗机构,问卷回收率为99.52%,假体植入手术总量为7475例;改进期共纳入624家医疗机构,问卷回收率为96.00%,手术总量为4813例。乳房假体与鼻/鼻基底假体植入手术合计占比在各地区各时期中均超过80%。感染例数分布方面,不同类别假体植入手术中,鼻/鼻基底占比最高,基线期为57.50%(23/40),改进期为62.86%(22/35)。乳房占比从基线期的40.00%(16/40)降至改进期的17.14%(6/35);各地区中,江西省改进后(100%)、贵州省基线(100%)及改进后(100%)的感染病例均集中于鼻/鼻基底假体。陕西省改进期出现4例颏假体感染(22.22%),重庆市改进期出现3例金属相关感染(27.27%)。感染率方面,重庆(0.55%比0.26%)和全区域(0.73%比0.54%)的改进感染率均高于基线期,陕西(0.93%比1.05%)、江西(0.29%比1.38%)、贵州(0.91%比1.22%)的改进感染率均低于基线期,差异均无统计学意义(P均>0.05)。重庆(1.43%比0,P=0.04)及全区域(1.22%比0,P=0.04)的金属相关假体改进感染率较基线期显著上升,同一地区的其他手术类别改进前后感染率相比差异均无统计学意义(P均>0.05)。结论 当前假体植入手术中,乳房假体与鼻/鼻基底假体为主要植入物类型。本研究所实施的改进策略在多个地区观察到手术早期手术部位感染率下降,提示该策略在我国假体植入术后早期感染防控工作中具有一定临床参考价值。

     

    Abstract: Objective To assess the current status of early surgical site infections following prosthetic implantation in plastic surgery across four provincial-level administrative regions in China, and to explore the effectiveness of standardized training for infection prevention and control. Methods From January to May 2025, an online questionnaire survey was conducted to perform a baseline investigation in medical institutions performing plastic and aesthetic prosthetic implant surgeries in Chongqing, Shaanxi, Jiangxi, and Guizhou provinces. Data were collected on the volume of various types of prosthetic implant surgeries and the corresponding incidence of early surgical site infections. Improvement strategies for the prevention and control of early surgical site infections in prosthetic implant surgeries were jointly developed by the National Medical Quality Control Center for Plastic and Aesthetic Surgery and the National Medical Quality Control Center for Hospital Infection Management, followed by promotion and training. Subsequently, post-implementation data from June to October 2025 were collected from the above regions, and comparisons were made between preand post-implementation periods across different regions and surgical categories. Results A total of 209 medical institutions were included in the baseline period, with a questionnaire response rate of 99.52% and a total of 7475 prosthetic implantation surgeries. In the post-implementation period, 624 medical institutions were included, with a response rate of 96.00% and a total of 4813 surgeries. The combined proportion of breast prosthesis implantation and nasal/nasal base prosthesis implantation surgeries consistently exceeded 80% across all regions and periods. Regarding the distribution of infection cases, among different types of prosthetic implant surgeries, nasal/nasal base prostheses accounted for the highest proportion, with 57.50% (23/40) at baseline and 62.86% 22/35) post-implementation. The proportion of breast prosthesis infections decreased from 40.00% (16/40) at baseline to 17.14% (6/35) post-implementation. Across different regions, infection cases in Jiangxi (post-implementation) (100%), Guizhouboth baseline (100%) and post-implementation (100%) were all concentrated in nasal/nasal base prostheses. Shaanxi reported four cases of chin prosthesis infections (22.22%) during the post-implementation period, and Chongqing reported three cases of metal-related infections (27.27%) during the post-implementation period. In terms of infection rates, Chongqing (0.55% vs.0.26%) and the overall combined regions (0.73% vs.0.54%) showed higher infection rates post-implementation compared to baseline, while Shaanxi (0.93% vs.1.05%), Jiangxi (0.29% vs.1.38%), and Guizhou (0.91% vs.1.22%) showed lower infection rates post-implementation; none of these differences reached statistical significance (all P > 0.05). The infection rate for metal-related prostheses increased significantly in Chongqing (1.43% vs.0, P=0.04) and in the overall combined regions (1.22% vs.0, P=0.04), while no significant differences were observed for other surgical categories within the same regions (all P > 0.05). Conclusions Breast prostheses and nasal/nasal base prostheses currently represent the main types of implants used in prosthetic implantation surgeries. The improvement strategies implemented in this study were associated with decreased early surgical site infection rates in multiple regions, suggesting that these strategies provide clinical insights for the prevention and control of early infections following prosthetic implantation surgeries in China.

     

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