017CQ 1-3ＳＳＩの定義、頻度、リスク因子第 １章表1-2 手術手技別のSSI危険因子APP（n＝2074）BILI（n＝2048）CHOL（n＝3460）COLO（n＝7273）OR95% CIP valueOR95% CIP valueOR95% CIP valueOR95% CIP value術中輸血あり1.770.42ｰ7.520.4372.031.46ｰ2.84＜0.0011.961.03ｰ3.720.0411.441.20ｰ1.73＜0.001糖尿病治療薬使用あり1.150.41ｰ3.210.7940.640.46ｰ0.890.0081.250.73ｰ2.110.4161.231.02ｰ1.490.028ステロイド使用あり1.40.47ｰ4.190.5491.20.80ｰ1.790.3752.831.44ｰ5.570.0031.271.01ｰ1.610.04免疫抑制剤使用あり2.920.47ｰ18.040.2485.470.50ｰ60.090.1650.550.27ｰ1.140.106手術時間（時）平均（SD）1.721.33ｰ2.22＜0.0011.231.16ｰ1.30＜0.0011.321.13ｰ1.54＜0.0011.181.12ｰ1.24＜0.001創分類3，43.192.01ｰ5.04＜0.0013.111.40ｰ6.920.0052.391.39ｰ4.100.0022.391.91ｰ3.01＜0.001ASA-PS3～50.850.30ｰ2.390.7590.70.46ｰ1.080.1040.760.43ｰ1.370.3641.20.99ｰ1.450.068緊急手術はい1.20.60ｰ2.400.6072.551.00ｰ6.490.050.650.34ｰ1.230.1841.210.96ｰ1.510.105腹腔鏡下手術はい0.680.41ｰ1.140.1440.590.35ｰ0.990.0460.310.20ｰ0.48＜0.0010.460.38ｰ0.56＜0.001人工肛門あり1.140.91ｰ1.410.249性別女性0.870.56ｰ1.350.5310.960.71ｰ1.300.790.620.40ｰ0.950.0290.930.80ｰ1.080.315入院時年齢1.011.00ｰ1.020.01810.99ｰ1.020.6181.041.02ｰ1.05＜0.00110.99ｰ1.010.81ESOP（n＝482）GAST（n＝4748）REC（n＝2762）SB（n＝1202）OR95% CIP valueOR95% CIP valueOR95% CIP valueOR95% CIP value術中輸血あり2.161.19ｰ3.910.0112.241.69ｰ2.97＜0.0011.551.16ｰ2.080.0031.160.76ｰ1.780.498糖尿病治療薬使用あり0.920.50ｰ1.690.7781.71.28ｰ2.25＜0.0011.250.93ｰ1.670.1371.130.72ｰ1.780.59ステロイド使用あり1.380.69ｰ2.780.361.240.82ｰ1.870.311.080.71ｰ1.640.7281.310.80ｰ2.140.282免疫抑制剤使用あり1.950.38ｰ9.920.4234.060.65ｰ25.420.1341.380.42ｰ4.500.598手術時間（時）平均（SD）1.221.07ｰ1.380.0021.291.19ｰ1.39＜0.0011.181.11ｰ1.26＜0.0011.411.24ｰ1.61＜0.001創分類3，46.471.01ｰ41.550.0492.141.22ｰ3.750.0081.831.20ｰ2.770.0052.111.41ｰ3.16＜0.001ASA-PS3～50.480.17ｰ1.350.1640.810.58ｰ1.150.2421.090.79ｰ1.520.6011.450.98ｰ2.160.066緊急手術はい3.890.56ｰ27.070.172.471.51ｰ4.05＜0.0011.871.21ｰ2.890.0051.180.79ｰ1.780.415腹腔鏡下手術はい1.530.66ｰ3.580.3210.510.37ｰ0.70＜0.0010.650.48ｰ0.870.0040.390.17ｰ0.880.024人工肛門あり1.421.09ｰ1.850.010.780.39ｰ1.550.478性別女性0.830.41ｰ1.680.5990.610.46ｰ0.810.0010.690.54ｰ0.880.0020.90.63ｰ1.280.556入院時年齢1.010.98ｰ1.040.411.021.01ｰ1.030.00410.99ｰ1.010.40410.99ｰ1.010.655APP：虫垂切除術，BILI：胆道再建を伴わない肝切除術，膵頭十二指腸切除術，その他の肝胆膵手術，CHOL：胆囊手術，COLO：結腸手術，ESOP：食道手術，GAST：胃手術，REC：直腸手術，SB：小腸手術．（文献10より）c 糖尿病Study糖尿病あり糖尿病なしWeightOdds RatioSSI（＋）TotalSSI（＋）TotalM-H, Fixed, 95% CIPessauxら（2003）4）1116618045521.90%1.72［0.92–3.23］Imaiら（2008）7）2813823415375.00%1.42［0.92–2.20］Watanabeら（2008）6）161131298284.30%0.89［0.51–1.57］Isikら（2015）9）2535116743393.80%1.92［1.24–2.96］Fukuda（2016)10）619427217121977784.90%1.79［1.62–1.97］Total （95% CI）504031033100.00%1.73［1.58–1.90］Total events6992422Heterogeneity：Chi2=6.75, df=4（P=0.15）；I2=41%Test for overall effect：Z=11.79（P＜0.00001）d 喫煙歴Study喫煙歴あり喫煙歴なしWeightOdds RatioSSI（＋）TotalSSI（＋）TotalM-H, Fixed, 95% CIWatanabeら（2008）6）281357457321.10%1.76［1.09–2.86］Isikら（2015）9）781794114289678.90%1.11［0.83–1.49］Total （95% CI）19293469100.00%1.25［0.97–1.60］Total events106188Heterogeneity：Chi²=2.60, df=1（P=0.11）；I²=61%Test for overall effect：Z=1.72（P=0.08）a ASAStudyASA≧3ASA≦2WeightOdds RatioSSI（＋）TotalSSI（＋）TotalM-H, Fixed, 95% CIWatanabeら（2008）6）331641137755.80%1.48［0.96–2.27］de Oliveiraら（2006）5）16561335533.20%1.26［0.69–2.33］Isikら（2015）9）751295117339511.30%1.72［1.28–2.32］Imaiら（2008）7）146924815703.10%1.36［0.74–2.48］Fukuda（2016）10）496347218352370774.50%1.99［1.79–2.21］Castroら（2011）8）226481782.10%0.23［0.05–0.99］Total （95% CI）508230178100.00%1.85［1.68–2.03］Total events6362494Heterogeneity：Chi2=13.30, df=5（P=0.02）；I2=62%Test for overall effect：Z=12.68（P＜0.00001）b BMIStudyBMI≧30BMI≦30WeightOdds RatioSSI（＋）TotalSSI（＋）TotalM-H, Fixed, 95% CIPessauxら（2003）4）24409167430934.70%1.55［1.00–2.40］de Oliveiraら（2006）5）601238948623.40%4.25［2.79–6.48］Isikら（2015）9）18461174422841.90%0.95［0.58–1.55］Total （95% CI）9939023100.00%1.93［1.51–2.46］Total events102430Heterogeneity：Chi²=22.37, df=2（P＜0.0001）；I²=91%Test for overall effect：Z=5.31（P＜0.00001）表1-3 消化器外科領域におけるSSI危険因子e 腹腔鏡下手術Study腹腔鏡下手術開腹手術WeightOdds RatioSSI（＋）TotalSSI（＋）TotalM-H, Fixed, 95% CIde Oliveiraら（2006）5）11931385162.50%0.37［0.19–0.71］Watanabeら（2008）6）131061338361.80%0.74［0.40–1.36］Imaiら（2008）7）6544919712266.00%0.88［0.65–1.20］Fukuda（2016）10）497930018341474989.70%0.40［0.36–0.44］Total （95% CI）994817327100.00%0.43［0.39–0.48］Total events5862302Heterogeneity：Chi2=27.06, df=3（P＜0.00001）；I2=89%Test for overall effect：Z=17.33（P＜0.00001）f 創分類Study創分類 3 or 4創分類 1 or 2WeightOdds RatioSSI（＋）TotalSSI（＋）TotalM-H, Fixed, 95% CIPessauxら（2003）4）117167074304810.40%3.03［2.25–4.08］de Oliveiraら（2006）5）311041185056.00%1.39［0.87–2.22］Imaiら（2008）7）83225416411.60%1.82［0.81–4.10］Watanabeら（2008）6）50129968123.40%4.72［3.12–7.14］Castroら（2011）8）431407701.40%3.99［1.69–9.42］Isikら（2015）9）105192087277014.40%1.78［1.33–2.39］Fukuda（2016）10）474237618572167362.80%2.66［2.38–2.97］Total （95% CI）637130519100.00%2.57［2.34–2.82］Total events8282493Heterogeneity：Chi2=24.19, df=6（P=0.0005）；I2=75%Test for overall effect：Z=19.94（P＜0.00001）
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