Advertisement

International Journal of Colorectal Disease

, Volume 31, Issue 2, pp 267–271 | Cite as

Risk factors for surgical site infection following colorectal resection: a multi-institutional study

  • Derek B. Hennessey
  • John P. Burke
  • Tara Ni-Dhonochu
  • Conor Shields
  • Desmond C. Winter
  • Kenneth Mealy
Original Article

Abstract

Introduction

Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly affects patients undergoing colorectal surgery. This study examined a multi-institutional dataset to determine risk factors for SSI following colorectal resection.

Methods

Data on 386 patients who underwent colorectal resection in three institutions were accrued. Patients were identified using a prospective SSI database and hospital records. Data are presented as median (interquartile range), and logistic regression analysis was used to identify risk factors.

Results

Patients (21.5 %) developed a postoperative SSI. The median time to the development of SSI was 7 days (5–10). Of all infections, 67.5 % were superficial, 22.9 % were deep and 9.6 % were organ space. In univariate analysis, an ASA grade of II (RR 0.6, CI 0.3–0.9, P = 0.019), having an elective procedure (RR 0.4, CI 0.2–0.6, P < 0.001), using a laparoscopic approach (RR 0.5, CI 0.3–0.9, P = 0.019), having a daytime procedure (RR 0.3, CI 0.1–0.7, P = 0.006) and having a clean/contaminated wound (RR 0.4, CI 0.2–0.7, P = 0.001) were associated with reduced risk of SSI. In multivariate analysis, an ASA grade of IV (RR 3.9, CI 1.1–13.7, P = 0.034), a procedure duration over 3 h (RR 4.3, CI 2.3–8.2, P < 0.001) and undergoing a panproctocolectomy (RR 6.5, CI 1.0–40.9, P = 0.044) were independent risk factors for SSI. Those who developed an SSI had a longer duration of inpatient stay (22 days [16–31] vs 15 days [10–26], P < 0.001).

Conclusions

Patients who develop an SSI have a longer duration of inpatient stay. Independent risk factors for SSI following colorectal resection include being ASA grade IV, having a procedure duration over 3 h, and undergoing a panproctocolectomy.

Keywords

Surgical site infection Colorectal surgery Wound infection Risk 

Notes

Compliance with ethical standards

Conflicts of interest

None to declare

References

  1. 1.
    Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20(5):271–274CrossRefPubMedGoogle Scholar
  2. 2.
    Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG et al (2004) Wound infection after elective colorectal resection. Ann Surg 239(5):599–605, discussion -7PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ (1999) The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 20(11):725–730CrossRefPubMedGoogle Scholar
  4. 4.
    Martone WJ, Gaynes RP, Horan TC, Danzig L, Emori TG, Monnet D et al (1995) National Nosocomial Infections Surveillance (NNIS) semiannual report, May 1995. A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control 23(6):377–385CrossRefPubMedGoogle Scholar
  5. 5.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132, quiz 3-4; discussion 96CrossRefPubMedGoogle Scholar
  6. 6.
    Bennett-Guerrero E, Pappas TN, Koltun WA, Fleshman JW, Lin M, Garg J et al (2010) Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery. N Engl J Med 363(11):1038–1049CrossRefPubMedGoogle Scholar
  7. 7.
    Stone HH, Hooper CA, Kolb LD, Geheber CE, Dawkins EJ (1976) Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann Surg 184(4):443–452PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Coppa GF, Eng K, Gouge TH, Ranson JH, Localio SA (1983) Parenteral and oral antibiotics in elective colon and rectal surgery. A prospective, randomized trial. Am J Surg 145(1):62–65CrossRefPubMedGoogle Scholar
  9. 9.
    Clarke JS, Condon RE, Bartlett JG, Gorbach SL, Nichols RL, Ochi S (1977) Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study. Ann Surg 186(3):251–259PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Kaiser AB, Herrington JL Jr, Jacobs JK, Mulherin JL Jr, Roach AC, Sawyers JL (1983) Cefoxitin versus erythromycin, neomycin, and cefazolin in colorectal operations. Importance of the duration of the surgical procedure. Ann Surg 198(4):525–530PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Goldring J, McNaught W, Scott A, Gillespie G (1975) Prophylactic oral antimicrobial agents in elective colonic surgery. A controlled trial. Lancet 2(7943):997–1000CrossRefPubMedGoogle Scholar
  12. 12.
    Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1990) Addition of parenteral cefoxitin to regimen of oral antibiotics for elective colorectal operations. A randomized prospective study. Ann Surg 212(2):209–212PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC et al (2001) 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 234(2):181–189PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Ata A, Valerian BT, Lee EC, Bestle SL, Elmendorf SL, Stain SC (2010) The effect of diabetes mellitus on surgical site infections after colorectal and noncolorectal general surgical operations. Am Surg 76(7):697–702PubMedGoogle Scholar
  15. 15.
    Anthony T, Murray BW, Sum-Ping JT, Lenkovsky F, Vornik VD, Parker BJ et al (2011) Evaluating an evidence-based bundle for preventing surgical site infection: a randomized trial. Arch Surg 146(3):263–269Google Scholar
  16. 16.
    Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211(2):232–238CrossRefPubMedGoogle Scholar
  17. 17.
    Poon JT, Law WL, Wong IW, Ching PT, Wong LM, Fan JK et al (2009) Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg 249(1):77–81CrossRefPubMedGoogle Scholar
  18. 18.
    Howard DP, Datta G, Cunnick G, Gatzen C, Huang A (2010) Surgical site infection rate is lower in laparoscopic than open colorectal surgery. Color Dis 12(5):423–427CrossRefGoogle Scholar
  19. 19.
    Degrate L, Garancini M, Misani M, Poli S, Nobili C, Romano F et al (2010) 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 Color DisGoogle Scholar
  20. 20.
    Uchino M, Ikeuchi H, Matsuoka H, Tsuchida T, Tomita N, Takesue Y (2010) Risk factors associated with surgical site infection after ileal pouch-anal anastomosis in ulcerative colitis. Dis Colon Rectum 53(2):143–149CrossRefPubMedGoogle Scholar
  21. 21.
    Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K (2010) Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg 252(2):325–329CrossRefPubMedGoogle Scholar
  22. 22.
    Leong G, Wilson J, Charlett A (2006) Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect 63(3):255–262CrossRefPubMedGoogle Scholar
  23. 23.
    Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG et al (1991) Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 91(3B):152S–157SCrossRefPubMedGoogle Scholar
  24. 24.
    Garibaldi RA, Cushing D, Lerer T (1991) Risk factors for postoperative infection. Am J Med 91(3B):158S–163SCrossRefPubMedGoogle Scholar
  25. 25.
    Lehtinen SJ, Onicescu G, Kuhn KM, Cole DJ, Esnaola NF (2010) Normothermia to prevent surgical site infections after gastrointestinal surgery: holy grail or false idol? Ann Surg 252(4):696–704PubMedCentralPubMedGoogle Scholar
  26. 26.
    Khoury W, Stocchi L, Geisler D (2010) Outcomes after laparoscopic intestinal resection in obese versus non-obese patients. Br J Surg 98(2):293–298CrossRefGoogle Scholar
  27. 27.
    Fujii T, Tsutsumi S, Matsumoto A, Fukasawa T, Tabe Y, Yajima R et al (2010) Thickness of subcutaneous fat as a strong risk factor for wound infections in elective colorectal surgery: impact of prediction using preoperative CT. Dig Surg 27(4):331–335CrossRefPubMedGoogle Scholar
  28. 28.
    Balentine CJ, Robinson CN, Marshall CR, Wilks J, Buitrago W, Haderxhanaj K et al (2010) Waist circumference predicts increased complications in rectal cancer surgery. J Gastrointest Surg 14(11):1669–1679CrossRefPubMedGoogle Scholar
  29. 29.
    Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 244(5):758–763PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Belda FJ, Aguilera L, Garcia de la Asuncion J, et al. (2005) Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. Jama 294(16):2035–42Google Scholar
  31. 31.
    Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334(19):1209–15Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Derek B. Hennessey
    • 1
    • 2
  • John P. Burke
    • 2
  • Tara Ni-Dhonochu
    • 3
  • Conor Shields
    • 3
  • Desmond C. Winter
    • 2
  • Kenneth Mealy
    • 1
  1. 1.Department of SurgeryWexford General HospitalWexfordIreland
  2. 2.St Vincent’s University HospitalDublin 4Ireland
  3. 3.Mater Misericordiae University HospitalDublin 7Ireland

Personalised recommendations