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Does umbilical contamination correlate with colorectal surgery patient outcomes?

  • Justin T. Brady
  • Alison R. Althans
  • Madhuri Nishtala
  • Scott R. Steele
  • Sharon L. Stein
  • Harry L. Reynolds
  • Conor P. Delaney
  • Emily SteinhagenEmail author
Original Article

Abstract

Purpose

Most preoperative assessment tools to evaluate risk for postoperative complications require multiple data points to be collected and can be logistically burdensome. This study evaluated if umbilical contamination, a simple bedside assessment, correlated with surgical outcomes.

Methods

A 6-point score to measure umbilical contamination was developed and applied prospectively to patients undergoing colorectal surgery at an academic medical center.

Results

There were 200 patients enrolled (mean age 58.1 ± 14.8; 56% female). The mean BMI was 28.6 ± 7.4. Indications for surgery included colon cancer (24%), rectal cancer (18%), diverticulitis (13.5%), and Crohn’s disease (12.5%). Umbilical contamination scores were 0 (23%, cleanest), 1 (26%), 2 (21%), 3 (24%), 4 (6%), and 5 (0%, dirtiest). Umbilical contamination did not correlate with preoperative functional status (p > 0.2). Umbilical contamination correlated with increased length of stay (rho = 0.19, p = 0.007) and postoperative complications (OR 1.3, 1.02–1.7, p = 0.04), but not readmission (p = 0.3) or discharge disposition (p > 0.2).

Conclusion

Sterile preparation of the abdomen is an important component of proper surgical technique and umbilical contamination correlates with increased postoperative complications.

Keywords

Colorectal surgery Outcomes Colon cancer Diverticulitis 

Notes

Acknowledgments

We acknowledge grant support from the Clinical and Translational Science Collaborative (CTSC, 4UL1TR000439) for hosting the REDCap tool.

Author contributions

Justin T. Brady: Conception and design, data collection, data analysis, writing manuscript and critical revisions, approving final version of manuscript

Alison R. Althans: Conception and design, data collection, writing manuscript and critical revisions, approving final version of the manuscript

Madhuri Nishtala: Conception and design, data collection, writing manuscript and critical revisions, approving final version of the manuscript

Scott R. Steele: Conception and design, data collection, writing manuscript and critical revisions, approving final version of the manuscript

Sharon L. Stein: Conception and design, data collection, writing manuscript and critical revisions, approving final version of the manuscript

Harry L. Reynolds: Conception and design, data collection, writing manuscript and critical revisions, approving final version of the manuscript

Conor P. Delaney: Conception and design, writing manuscript and critical revisions, approving final version of the manuscript

Emily Steinhagen: Conception and design, data collection, writing manuscript and critical revisions, approving final version of the manuscript

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity Hospitals Cleveland Medical CenterClevelandUSA
  2. 2.Department of Colorectal SurgeryCleveland ClinicClevelandUSA
  3. 3.Digestive Disease and Surgical InstituteCleveland ClinicClevelandUSA

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