Surgery Today

, Volume 44, Issue 7, pp 1242–1252

Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management

  • Keita Itatsu
  • Gen Sugawara
  • Yuji Kaneoka
  • Takehito Kato
  • Eiji Takeuchi
  • Michio Kanai
  • Hiroshi Hasegawa
  • Toshiyuki Arai
  • Yukihiro Yokoyama
  • Masato Nagino
Original Article

DOI: 10.1007/s00595-013-0677-3

Cite this article as:
Itatsu, K., Sugawara, G., Kaneoka, Y. et al. Surg Today (2014) 44: 1242. doi:10.1007/s00595-013-0677-3

Abstract

Purpose

An incisional surgical site infection (I-SSI) is a frequently observed complication following colorectal surgery. Intraoperative wound management is one of the most important factors that determine the incidence of postoperative I-SSI. The purpose of this study was to assess the impact of the methods used for intraoperative wound management on the incidence of I-SSI following elective surgery for colorectal cancer.

Methods

Between November 2009 and February 2011, the data of 1,980 consecutive patients who underwent elective colorectal resection for colorectal cancer were prospectively collected from 19 affiliated hospitals. The incidence of and risk factors for I-SSI were investigated.

Results

Overall, 233 I-SSIs were identified (11.7 %). Forty-two possible risk factors were analyzed. Using a multivariate analysis, the independent risk factors for I-SSI were identified to be a high body mass index, previous laparotomy, chronic liver disease, wound length, contaminated wound class, creation or closure of an ostomy, right hemicolectomy procedure, the suture material used for fascial closure and the incidence of organ/space SSI.

Conclusion

To prevent I-SSI following elective colorectal surgery, it is crucial to avoid making large incisions and reduce fecal contamination whenever possible. A high quality randomized control trial is necessary to confirm the definitive intraoperative procedure(s) that can minimize the incidence of I-SSI.

Keywords

Incisional surgical site infection Elective colorectal surgery Intraoperative wound management 

Abbreviations

ASA

American Society of Anesthesia

APR

Abdominoperineal resection

BMI

Body mass index

CDC

The Centers for Disease and Control

CI

Confidence interval

COPD

Chronic obstructive pulmonary disease

CT

Computed tomography

HAR

High anterior resection

ISR

Internal sphincter resection

I-SSI

Incisional surgical site infection

LAR

Low anterior resection

LHC

Left hemicolectomy

OR

Odds ratio

RCT

Randomized control trial

RHC

Right hemicolectomy

SSI

Surgical site infection

Sig

Sigmoidectomy

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Keita Itatsu
    • 1
    • 2
  • Gen Sugawara
    • 1
    • 2
  • Yuji Kaneoka
    • 3
  • Takehito Kato
    • 4
  • Eiji Takeuchi
    • 5
  • Michio Kanai
    • 6
  • Hiroshi Hasegawa
    • 7
  • Toshiyuki Arai
    • 8
  • Yukihiro Yokoyama
    • 1
  • Masato Nagino
    • 1
  1. 1.The Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.The Division of Surgical InfectionNagoya University Graduate School of MedicineNagoyaJapan
  3. 3.Department of SurgeryOgaki Municipal HospitalOgakiJapan
  4. 4.Department of General SurgeryToyohashi Municipal HospitalToyohashiJapan
  5. 5.Department of General SurgeryJapanese Red Cross Nagoya Daiichi HospitalNagoyaJapan
  6. 6.Department of SurgeryKasugai Municipal HospitalKasugaiJapan
  7. 7.Department of General SurgeryJapanese Red Cross Nagoya Daini HospitalNagoyaJapan
  8. 8.Department of General SurgeryAnjo Kosei HospitalAnjoJapan

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