Surgery Today

, Volume 48, Issue 3, pp 338–345 | Cite as

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

  • Marta SilvestriEmail author
  • Chiara Dobrinja
  • Serena Scomersi
  • Fabiola Giudici
  • Angelo Turoldo
  • Elija Princic
  • Roberto Luzzati
  • Nicolò de Manzini
  • Marina Bortul
Original Article



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.


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.


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.


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.


Abdominal infections Surgical site infection Colorectal surgery 


Compliance with ethical standards

Conflict of interest

We declare no conflicts of interest in relation to this study.


  1. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 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.Google Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 4.
    NICE Clinical Guidelines. Surgical site infection. Prevention and treatment of surgical site infection. London: RCOG Press; 2008.Google Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 7.
    Awad SS. Adherence to surgical care improvement project measures and postoperative surgical site infections. Surg Infect (Larchmt). 2012;13(4):234–7.CrossRefGoogle Scholar
  8. 8.
    Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70(2):3–10.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.Google Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.Google Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.Google Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.PubMedPubMedCentralGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 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.PubMedPubMedCentralGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 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.Google Scholar
  36. 36.
    Shogan BD, Carlisle EM, Alverdy JC, Umanskiy K. Do we really know why colorectal anastomoses leak? J Gastrointest Surg. 2013;17:1698–707.CrossRefPubMedGoogle Scholar
  37. 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.CrossRefGoogle Scholar
  38. 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.Google Scholar
  39. 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.CrossRefPubMedGoogle Scholar
  40. 40.
    Aimaq R, Akopian G, Kaufman HS. Surgical site infection rates in laparoscopic versus open colorectal surgery. Am Surg. 2011;77(10):1290–4.PubMedGoogle Scholar
  41. 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.CrossRefPubMedGoogle Scholar
  42. 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.Google Scholar

Copyright information

© Springer Japan KK 2017

Authors and Affiliations

  • Marta Silvestri
    • 1
    Email author
  • Chiara Dobrinja
    • 1
  • Serena Scomersi
    • 1
  • Fabiola Giudici
    • 1
  • Angelo Turoldo
    • 1
  • Elija Princic
    • 1
  • Roberto Luzzati
    • 2
  • Nicolò de Manzini
    • 1
  • Marina Bortul
    • 1
  1. 1.Division of General Surgery, Department of Medical and Surgical SciencesHospital of Cattinara, University of TriesteTriesteItaly
  2. 2.Division of Infective DiseasesASUITS and University of TriesteTriesteItaly

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