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

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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.


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.


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.


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.

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American Society of Anesthesia


Abdominoperineal resection


Body mass index


The Centers for Disease and Control


Confidence interval


Chronic obstructive pulmonary disease


Computed tomography


High anterior resection


Internal sphincter resection


Incisional surgical site infection


Low anterior resection


Left hemicolectomy


Odds ratio


Randomized control trial


Right hemicolectomy


Surgical site infection




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In addition to the authors listed on the title page, the following investigators participated in this study: Hitoshi Kubota, M.D., Handa City Hospital; Yuichiro Tojima, M.D., Social Insurance Chukyo Hospital; Yasuhiro Kurumiya, M.D., Toyota Kosei Hospital; Hiroshi Kono, M.D., Nagoya Ekisaikai Hospital; Hideo Yamamoto, M.D., Tokai Hospital; Kazuhisa Shirai, M.D., Yamashita Hospital; Satoaki Kamiya, M.D., Tsushima City Hospital; Akira Ishikawa, M.D., Chubu Rosai Hospital; Shinsuke Iyomasa, M.D., Yachiyo Hospital; Masaki Terasaki, M.D., Shizuoka Saiseikai General Hospital; Atsushi Morioka, M.D., Kumiai Kosei Hospital; and Makoto Kato, M.D., Kamiiida Daiichi General Hospital.

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Correspondence to Masato Nagino.

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Itatsu, K., Sugawara, G., Kaneoka, Y. et al. Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management. Surg Today 44, 1242–1252 (2014).

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