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Surgery Today
Published in: Surgery Today 3/2018

01-03-2018 | Original Article

Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience

Authors: Marta Silvestri, Chiara Dobrinja, Serena Scomersi, Fabiola Giudici, Angelo Turoldo, Elija Princic, Roberto Luzzati, Nicolò de Manzini, Marina Bortul

Published in: Surgery Today | Issue 3/2018

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Abstract

Purpose

Surgical site infection (SSI) is the most common complication of colorectal surgery, resulting in significant burden in terms of morbidity and length of hospital stay. The aims of this study were to establish the incidence of SSI in patients undergoing colorectal surgeries and to identify potentially modifiable risk factors to reduce overall SSI rates.

Methods

This retrospective study analyzed patients who underwent colorectal resection at our Department. Patients were identified using a prospective SSI database. Univariate and multivariate analyses were used to identify risk factors.

Results

A total of 687 patients were enrolled in the study and the overall SSI rate was 19.9% (137 patients). Superficial incisional surgical site infections (SSSIs) developed in 52 (7.6%) patients, deep incisional surgical site infections (DSSIs) developed in 15 (2.2%), and organ/space infections (OSIs) developed in 70 (10.1%). Univariate and multivariate analyses confirmed that age, diabetes, emergency surgery, and a high infection risk index are risk factors for SSI.

Conclusions

There are some modifiable and non-modifiable risk factors for SSI. IRI and age are non-modifiable, whereas the timing of surgery and diabetes can be modulated by trying to defer some emergency procedures to elective ones and normalizing the glycemia of diabetic patients.
Literature
1.
Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122:160–6.CrossRefPubMedPubMedCentral
2.
CDC National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 to June 2003, issued August 2003. Am J Infect Control 2003;31:481–98.
3.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999;20(4):250–78.CrossRefPubMed
4.
NICE Clinical Guidelines. Surgical site infection. Prevention and treatment of surgical site infection. London: RCOG Press; 2008.
5.
de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009;37(5):627–37.CrossRef
6.
Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668.CrossRefPubMed
7.
Awad SS. Adherence to surgical care improvement project measures and postoperative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234–7.CrossRef
8.
Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70(2):3–10.CrossRefPubMed
9.
Saeed MJ, Dubberke ER, Fraser VJ, Olsen MA. Procedure-specific surgical site infection incidence varies widely within certain National Healthcare Safety Network surgery groups. Am J Infect Control. 2015;43(6):617–23.CrossRefPubMedPubMedCentral
10.
Wick EC, Vogel JD, Church JM, Remzi F, Fazio VW. Surgical site infections in a “high outlier” institution: are colorectal surgeons to blame? Dis Colon Rectum. 2009;52(3):374–9.CrossRefPubMed
11.
Kobayashi M, Mohri Y, Inoue Y, Okita Y, Miki C, Kusunoki M. Continuous follow-up of surgical site infections for 30 days after colorectal surgery. World J Surg. 2008;32(6):1142–6.CrossRefPubMed
12.
Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, et al. Wound infection after elective colorectal resection. Ann Surg. 2004;239(5):599–607.CrossRefPubMedPubMedCentral
13.
Magill SS, Hellinger W, Cohen J, Kay R, Bailey C, Boland B, et al. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonwille, Florida. Infect Control Hosp Epidemiol. 2012;33(3):283–91.CrossRefPubMedPubMedCentral
14.
Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, et al. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2809 consecutive patients. Ann Surg. 2001;234(2):181–9.CrossRefPubMedPubMedCentral
15.
Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 Update. Infect Control Hosp Epidemiol. 2014;35(6):605–27.CrossRefPubMedPubMedCentral
16.
Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML, et al. Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis. 2008;8:34.CrossRefPubMedPubMedCentral
17.
Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J. Post-discharge surveillance to identify colorectal surgical site infection rates and costs. J Hosp Infect. 2009;72:242–50.CrossRef
18.
Keenan JE, Speicher PJ, Thacker JK, Walter M, Kuchibhatla M, Mantyh CR. The preventive surgical site infection bundle in colorectal surgery. An effective approach to surgical site infection reduction and health care cost savings. JAMA Surg 2014;149(10):1045–1052.
19.
Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis. 2006;43(3):322–30.CrossRefPubMed
20.
Nguyen N, Yegiyants S, Kaloostian C, Abbas MA, Difronzo LA. The Surgical Care Improvement Project (SCIP) initiative to reduce infection in elective colorectal surgery: which performance measures affect outcome? Am Surg 2008;74(10):1012–1016.
21.
Tanner J, Padley W, Assadian O, Leaper D, Kiernan M, Edmiston C. Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8515 patients. Surgery. 2015;158(1):66–77.CrossRefPubMed
22.
Lawson EH, Hall BL, Ko CY. Risk factors for superficial vs deep/organ-space surgical site infections. Implication for quality improvement initiatives. JAMA Surg 2013;148(9):1–10.
23.
Hedrick TL, Sawyer RG, Friel CM, Stukenborg GJ. A method for estimating the risk of surgical site infection in patients with abdominal colorectal procedures. Dis Colon Rectum. 2013;56(5):627–37.CrossRefPubMed
24.
Gervaz P, Bandiera-Clerc C, Buchs NC, Eisenring MC, Troillet N, Perneger T, et al. Scoring system to predict the risk of surgical-site infection after colorectal resection. Br J Surg. 2012;99(4):589–95.CrossRefPubMed
25.
Kurmann A, Vorburger SA, Candinas D, Beldi G. Operation time and body mass index are significant risk factors for surgical site infection in laparoscopic sigmoid resection: a multicenter study. Surg Endosc. 2011;25(11):3531–4.CrossRefPubMed
26.
Amri R, Bordeianou LG, Sylla P, Berger DL. Obesity, outcomes and quality of care: body mass index increases the risk of wound-related complications in colon cancer surgery. Am J Surg. 2014;207(1):17–23.CrossRefPubMed
27.
Lutfiyya W, Parsons D, Breen J. A colorectal “care bundle” to reduce surgical site infections in colorectal surgery: a single-center experience. Perm J. 2012;16(3):10–6.PubMedPubMedCentral
28.
Pastor C, Baek JH, Varma MG, Kim E, Indorf LA, Garcia-Aguilar J. Validation of the risk index category as a predictor of surgical site infection in elective colorectal surgery. Dis Colon Rectum. 2010;53(5):721–7.CrossRefPubMed
29.
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):758–63.CrossRefPubMedPubMedCentral
30.
Degrate L, Garancini M, Misani M, Poli S, Nobili C, Romano F, et al. Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections. Int J Colorectal Dis. 2011;26(1):61–9.CrossRefPubMed
31.
Ishikawa K, Kusumi T, Hosokawa M, Nishida Y, Sumikawa S, Furukawa H. Incisional surgical site infection after elective open surgery for colorectal cancer. Int J Surg Oncol. 2014;2014:419712.PubMedPubMedCentral
32.
Ata A, Lee J, Bestle SL, Desemone J, Stain SC. Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg. 2010;145(9):858–64.CrossRefPubMed
33.
McConnell YJ, Johnson PM, Porter GA. Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia. J Gastrointes Surg. 2009;13:508–15.CrossRef
34.
McConnell YJ, Johnson PM, Porter GA. Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia. J Gastrointest Surg. 2009;13(3):508–15.CrossRefPubMed
35.
Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery. Ann Surg 2010;252:325–329.
36.
Shogan BD, Carlisle EM, Alverdy JC, Umanskiy K. Do we really know why colorectal anastomoses leak? J Gastrointest Surg. 2013;17:1698–707.CrossRefPubMed
37.
Watanabe M, Suzuki H, Nomura S, Maejima K, Chihara N, Komine O, et al. Risk factors for surgical site infection in emergency colorectal surgery: a retrospective analysis. Surg Infect (Larcht). 2014;15(3):256–61.CrossRef
38.
Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(3):152S–157S.
39.
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 Coll Surg. 2010;211(2):232–8.CrossRefPubMed
40.
Aimaq R, Akopian G, Kaufman HS. Surgical site infection rates in laparoscopic versus open colorectal surgery. Am Surg. 2011;77(10):1290–4.PubMed
41.
Drosdeck J, Harzman A, Suzo A, Arnold M, Abdel-Rasoul M, Husain S. Multivariate analysis for surgical site infection after laparoscopic colorectal surgery. Surg Endosc. 2013;27:4574–80.CrossRefPubMed
42.
Watanabe M, Suzuki H, Nomura S, Hanawa H, Chihara N, Mizutani S, et al. Performance assessment of the risk index category for surgical site infection after colorectal surgery. Surg Infect 2015;16(1):84–89.
Metadata
Title
Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience
Authors
Marta Silvestri
Chiara Dobrinja
Serena Scomersi
Fabiola Giudici
Angelo Turoldo
Elija Princic
Roberto Luzzati
Nicolò de Manzini
Marina Bortul
Publication date
01-03-2018
Publisher
Springer Singapore
Published in
Surgery Today / Issue 3/2018
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-017-1590-y

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