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01-02-2015 | Original Article

Surgical Site Infections (SSIs) After Stoma Reversal (SR): Risk Factors, Implications, and Protective Strategies

Authors: Daniel I. Chu, Christopher R. Schlieve, Dorin T. Colibaseanu, Paul J. Simpson, Amy E. Wagie, Robert R. Cima, Elizabeth B. Habermann

Published in: Journal of Gastrointestinal Surgery | Issue 2/2015

Abstract

Background

Stoma reversals (SRs) are commonly performed with potentially significant postoperative complications including surgical site infections (SSIs). Our aim was to determine the incidence and risk factors for SSIs in a large cohort of SR patients.

Design

We reviewed our institutional 2006–2011 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for 30-day SSIs in patients undergoing SR. Records were additionally reviewed for 10 non-ACS-NSQIP variables. The primary outcome was SSI after SR. Secondary outcomes were additional 30-day postoperative complications and length-of-stay. Predictors of SSIs were identified using multivariable logistic regression.

Results

From 528 SR patients, 36 patients developed a SSI (6.8 %). Most patients underwent SR for loop ileostomies (76.5 %) after index operations for ulcerative colitis (38.6 %) and colorectal cancer (27.8 %). SSI patients had fewer subcutaneous drains compared to patients with no SSI and had significantly higher rates of smoking, ASA 3–4 classification and laparotomies at SR (p < 0.05). Patients with SSI had increased length-of-stay and 30-day morbidities including sepsis and returns to the operating room (p < 0.05) compared to no-SSI patients. On multivariable analysis, subcutaneous drain placement was suggestive of SSI protection (odds ratio [OR] 0.52, 95 % confidence interval [CI] 0.2–1.1), but only smoking was significantly associated with an increased risk for SSI (OR 2.4, 95 % CI 1.1–5.4).

Conclusions

Smoking increased the risk of SR SSIs in patients by over twofold, and SR SSIs are associated with additional significant morbidities. Smoking cessation should be an important part of any SSI risk-reduction strategy.

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Title: Surgical Site Infections (SSIs) After Stoma Reversal (SR): Risk Factors, Implications, and Protective Strategies
Authors: Daniel I. Chu
Christopher R. Schlieve
Dorin T. Colibaseanu
Paul J. Simpson
Amy E. Wagie
Robert R. Cima
Elizabeth B. Habermann
Publication date: 01-02-2015
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 2/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2649-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Surgical Site Infections (SSIs) After Stoma Reversal (SR): Risk Factors, Implications, and Protective Strategies

Abstract

Background

Design

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Design

Results

Conclusions

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