Top

Journal of Gastrointestinal Surgery

Published in:

01-10-2014 | Original Article

Crohn’s Disease but not Diverticulitis Is an Independent Risk Factor for Surgical Site Infections in Colectomy

Authors: Matthew Wideroff, Yunfan Xing, Junlin Liao, John C. Byrn

Published in: Journal of Gastrointestinal Surgery | Issue 10/2014

Abstract

Introduction

Surgical site infections (SSIs) after colectomy for colon cancer (CC), Crohn’s disease (CD), and diverticulitis (DD) significantly impact both the immediate postoperative course and long-term disease-specific outcomes. We aim to profile the effect of diagnosis on SSI after segmental colectomy using the National Surgical Quality Improvement Program (NSQIP) data set.

Method

NSQIP data from 2006 to 2011 were investigated, and segmental colectomy procedures performed for the diagnoses of Crohn’s disease, DD, and colon malignancy were included. SSI complications were compared by diagnosis using univariate and multivariate analysis.

Result

We included 35,557 colectomy cases in the analysis. CD had the highest rate of postoperative SSI (17 vs. 13 % DD vs. 10 % CC; p < 0.001). Using CC as the comparison group and controlling for multiple variables, the multivariate analysis showed that the CD group had an increased risk for acquiring at least one SSI (odds ratio (OR) = 1.38, p ≤ 0.001), deep incisional SSI (OR = 1.85, p = 0.03), and organ space SSI (OR = 1.51, p = 0.02).

Conclusion

For patients undergoing segmental colectomy in the NSQIP data set, statistically significant increases in SSI are seen in CD, but not DD, when compared to CC, thus confirming CD as an independent risk factor for SSI.

Available only for authorised users

Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990’s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control HospEpidemiol 1999;20:725-730.CrossRef

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control HospEpidemiol 1999;20:247-278.

National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-Apirl 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control 1996;24:380–388.

Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9(2):196-203.PubMedCrossRefPubMedCentral

Sparling KW, Ryckman FC, Schoettker PJ, Byczkowski TL, Helpling A, Mandel K, Panchanathan A, Kotagal UR. Financial impact of failing to prevent surgical site infections. Q Manage Health Care 2007;16(3):219-225.CrossRef

Cheung WY, Neville BA, Earle CC. Etiology of delays in the initiation of adjuvant chemotherapy and their impact on outcomes for Stage II and III rectal cancer. Dis Colon Rectum 2009;52(6):1054-1063.PubMedCrossRef

Khoury W, Strong S, Fazio V, Kiran R. Factors associated with operative recurrence early after resection for Crohn’s disease. J GastrointestSurg 2011;15:1354-1360.CrossRef

Merkow R, Bentrem D, Mulcahy M, Chung J, Abbott D, Kmiecik T, Stewart A, Winchester D, Ko C, Bilimoria K. Effect of postoperative complications on adjuvant chemotherapy use for stage III colon cancer. Ann Surg 2013;258(6):847-853.PubMedCrossRef

Nespoli A, Gianotti L, Bovo G, Brivio F, Nespoli L, Totis M. Impact of postoperative infections on survival in colon cancer patients. Surgical Infections 2006;7(2):S41-43.PubMed

10.

Van Arendonk K, Tymitz K, Gearhart S, Stem M, Lidor A. Outcomes and costs of elective surgery for diverticular disease. JAMA Surg 2013;148(4):316-321.PubMedCrossRef

11.

Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH. Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am CollSurg 2010;211:232-238.

12.

Pendlimari R, Cima R, Wolff B, Pemberton J, Huebner M. Diagnoses influence surgical site infections (SSI) in colorectal surgery: a must consideration for SSI reporting programs? J Am CollSurg 2012;214:574-581.

13.

Eskicioglu C, Nelson J, Roberts PL, Marcello PW, Read TE, Hall JF, Schoetz DJ, Ricciardi R. Is patient diagnosis a risk factor for organ space infection after colorectal resections? Dis Colon Rectum 2014;57(6):733-739.PubMedCrossRef

14.

American College of Surgeons National Surgical Quality Improvement Program Data User Guide. September 2011.

15.

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control. 1992;20(5):271-274.PubMedCrossRef

16.

Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 2006;244(5):758-763.PubMedCrossRefPubMedCentral

17.

Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF. Wound infection after elective colorectal resection. Ann Surg 2004;239(5):599-605.PubMedCrossRefPubMedCentral

18.

Tang R, Chen H, Wang Y, Changchien C, Chen J, Hsu K, Chiang J, Wang J. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg 2001;234:181-189.PubMedCrossRefPubMedCentral

19.

Regenbogen S, Read T, Roberts P, Marcello P, Schoetz D, Ricciardi R. Urinary tract infection after colon and rectal resections: more common than predicted by risk-adjustment models. J Am CollSurg 2011;213(6):784-792.

20.

Longo WE, Virgo KS, Johnson FE, Oprian CA, Vernava AM, Wade TP, Phelan MA, Henderson WG, Daley J, Khuri SF. Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 2000;43(1):83-91.PubMedCrossRef

Title: Crohn’s Disease but not Diverticulitis Is an Independent Risk Factor for Surgical Site Infections in Colectomy
Authors: Matthew Wideroff
Yunfan Xing
Junlin Liao
John C. Byrn
Publication date: 01-10-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 10/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2602-5

At a glance: The STEP trials

Springer Medicine

Crohn’s Disease but not Diverticulitis Is an Independent Risk Factor for Surgical Site Infections in Colectomy

Abstract

Introduction

Method

Result

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Method

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2014

Retroperitoneal Unicentric Castleman’s Disease—A Hyaline Vascular Challenge

Prognostic Implications of the Number of Retrieved Lymph Nodes of Patients with Rectal Cancer Treated with Preoperative Chemoradiotherapy

High Performing Whipple Patients: Factors Associated with Short Length of Stay after Open Pancreaticoduodenectomy

Laparoscopic Morgagni Hernia Repair: How I Do It

Validation of an Acoustic Gastrointestinal Surveillance Biosensor for Postoperative Ileus

The First Clinical Application of the Spiral Intestinal Lengthening and Tailoring (Silt) in Extreme Short Bowel Syndrome