Skip to main content
Top
Published in: Gastric Cancer 2/2016

01-04-2016 | Original Article

Risk factors for superficial incisional surgical site infection after gastrectomy: analysis of patients enrolled in a prospective randomized trial comparing skin closure methods

Authors: Shunji Endo, Toshimasa Tsujinaka, Kazumasa Fujitani, Junya Fujita, Shigeyuki Tamura, Makoto Yamasaki, Shogo Kobayashi, Yusuke Akamaru, Tsunekazu Mizushima, Junzo Shimizu, Koji Umeshita, Toshinori Ito, Masaki Mori, Yuichiro Doki

Published in: Gastric Cancer | Issue 2/2016

Login to get access

Abstract

Background

Surgical site infection is one of the commonest complications of gastrointestinal surgery. The nature of surgical procedures and wound closure methods may influence the incidence of superficial incisional surgical site infection. Patients enrolled in a prospective randomized controlled trial comparing skin closure methods are the best subjects for analyzing surgical site infection risk.

Method

From a cohort of 1080 patients who had been enrolled in our previous randomized controlled trial, data for 685 patients who had undergone elective open total gastrectomy or distal gastrectomy for gastric cancer were extracted. The incidences of superficial incisional surgical site infection after total gastrectomy and distal gastrectomy were compared and risk factors for superficial incisional surgical site infection were investigated by univariate analyses using logistic regression models.

Results

In all, 42 patients (6.1 %) developed superficial incisional surgical site infections after gastrectomy; 15 of 288 patients (5.2 %) developed these infections after total gastrectomy, and 27 of 397 patients (6.8 %) developed these infections after distal gastrectomy—these differences are not significant. According to univariate analysis, age (75 years or older or younger than 75 years) was the only risk factor for superficial incisional surgical site infections (P = 0.049). There was a tendency for the incidence of superficial incisional surgical site infection to increase in parallel with age.

Conclusion

The incidence of superficial incisional surgical site infection did not differ between total gastrectomy and distal gastrectomy. Advanced age was the only identified risk factor for superficial incisional surgical site infections after gastrectomy.
Literature
1.
go back to reference Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999;20:250–78.CrossRefPubMed Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999;20:250–78.CrossRefPubMed
2.
go back to reference Mu Y, Edwards JR, Horan TC, Berrios-Torres SI, Fridkin SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol. 2011;32:970–86.CrossRefPubMed Mu Y, Edwards JR, Horan TC, Berrios-Torres SI, Fridkin SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol. 2011;32:970–86.CrossRefPubMed
4.
go back to reference Fujitani K, Tsujinaka T, Fujita J, Miyashiro I, Imamura H, Kimura Y, et al. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer. Br J Surg. 2012;99:621–9.CrossRefPubMed Fujitani K, Tsujinaka T, Fujita J, Miyashiro I, Imamura H, Kimura Y, et al. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer. Br J Surg. 2012;99:621–9.CrossRefPubMed
5.
go back to reference Imamura H, Kurokawa Y, Tsujinaka T, Inoue K, Kimura Y, Iijima S, et al. Intraoperative versus extended antimicrobial prophylaxis after gastric cancer surgery: a phase 3, open-label, randomised controlled, non-inferiority trial. Lancet Infect Dis. 2012;12:381–7.CrossRefPubMed Imamura H, Kurokawa Y, Tsujinaka T, Inoue K, Kimura Y, Iijima S, et al. Intraoperative versus extended antimicrobial prophylaxis after gastric cancer surgery: a phase 3, open-label, randomised controlled, non-inferiority trial. Lancet Infect Dis. 2012;12:381–7.CrossRefPubMed
6.
go back to reference Tsujinaka T, Yamamoto K, Fujita J, Endo S, Kawada J, Nakahira S, et al. Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery: a phase 3, multicentre, open-label, randomised controlled trial. Lancet. 2013;382:1105–12.CrossRefPubMed Tsujinaka T, Yamamoto K, Fujita J, Endo S, Kawada J, Nakahira S, et al. Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery: a phase 3, multicentre, open-label, randomised controlled trial. Lancet. 2013;382:1105–12.CrossRefPubMed
7.
go back to reference Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients (in Japanese with English abstract). J Jpn Surg Soc. 1984;85:1001–5. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients (in Japanese with English abstract). J Jpn Surg Soc. 1984;85:1001–5.
8.
go back to reference Endo S, Yoshikawa Y, Hatanaka N, Tominaga H, Shimizu Y, Hiraoka K, et al. Treatment for gastric carcinoma in the oldest old patients. Gastric Cancer. 2011;14:139–43.CrossRefPubMed Endo S, Yoshikawa Y, Hatanaka N, Tominaga H, Shimizu Y, Hiraoka K, et al. Treatment for gastric carcinoma in the oldest old patients. Gastric Cancer. 2011;14:139–43.CrossRefPubMed
9.
go back to reference National Collaborating Centre for Women’s and Children’s Health. Surgical site infection: prevention and treatment of surgical site infection. London: RCOG Press; 2008. p. 15–20. National Collaborating Centre for Women’s and Children’s Health. Surgical site infection: prevention and treatment of surgical site infection. London: RCOG Press; 2008. p. 15–20.
10.
go back to reference Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br. 2005;87:844–50.CrossRefPubMed Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br. 2005;87:844–50.CrossRefPubMed
11.
go back to reference Cruse PJ. Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973;107:206–10.CrossRefPubMed Cruse PJ. Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973;107:206–10.CrossRefPubMed
12.
go back to reference Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr. 1987;11:8–13.CrossRef Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr. 1987;11:8–13.CrossRef
13.
go back to reference Tsujinaka T, Sasako M, Yamamoto S, Sano T, Kurokawa Y, Nashimoto A, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol. 2007;14:355–61.CrossRefPubMed Tsujinaka T, Sasako M, Yamamoto S, Sano T, Kurokawa Y, Nashimoto A, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol. 2007;14:355–61.CrossRefPubMed
14.
go back to reference Hirao M, Tsujinaka T, Imamura H, Kurokawa Y, Inoue K, Kimura Y, et al. Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer. Gastric Cancer. 2013;16:239–44.CrossRefPubMed Hirao M, Tsujinaka T, Imamura H, Kurokawa Y, Inoue K, Kimura Y, et al. Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer. Gastric Cancer. 2013;16:239–44.CrossRefPubMed
15.
go back to reference Cho M, Kang J, Kim IK, Lee KY, Sohn SK. Underweight body mass index as a predictive factor for surgical site infections after laparoscopic appendectomy. Yonsei Med J. 2014;55:1611–6.CrossRefPubMedPubMedCentral Cho M, Kang J, Kim IK, Lee KY, Sohn SK. Underweight body mass index as a predictive factor for surgical site infections after laparoscopic appendectomy. Yonsei Med J. 2014;55:1611–6.CrossRefPubMedPubMedCentral
16.
go back to reference Esemuede IO, Murray AC, Lee-Kong SA, Feingold DL, Kiran RP. Obesity, regardless of comorbidity, influences outcomes after colorectal surgery-time to rethink the pay-for-performance metrics? J Gastrointest Surg. 2014;18:2163–8.CrossRefPubMed Esemuede IO, Murray AC, Lee-Kong SA, Feingold DL, Kiran RP. Obesity, regardless of comorbidity, influences outcomes after colorectal surgery-time to rethink the pay-for-performance metrics? J Gastrointest Surg. 2014;18:2163–8.CrossRefPubMed
Metadata
Title
Risk factors for superficial incisional surgical site infection after gastrectomy: analysis of patients enrolled in a prospective randomized trial comparing skin closure methods
Authors
Shunji Endo
Toshimasa Tsujinaka
Kazumasa Fujitani
Junya Fujita
Shigeyuki Tamura
Makoto Yamasaki
Shogo Kobayashi
Yusuke Akamaru
Tsunekazu Mizushima
Junzo Shimizu
Koji Umeshita
Toshinori Ito
Masaki Mori
Yuichiro Doki
Publication date
01-04-2016
Publisher
Springer Japan
Published in
Gastric Cancer / Issue 2/2016
Print ISSN: 1436-3291
Electronic ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-015-0494-z

Other articles of this Issue 2/2016

Gastric Cancer 2/2016 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.