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Outcomes are Local: Patient, Disease, and Procedure-Specific Risk Factors for Colorectal Surgical Site Infections from a Single Institution

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Colorectal surgical site infections (SSIs) contribute to postoperative morbidity, mortality, and resource utilization. Risk factors associated with colorectal SSI are well-documented. However, quality improvement efforts are informed by national data, which may not identify institution-specific risk factors.

Method

Retrospective cohort study of colorectal surgery patients uses institutional ACS-NSQIP data from 2006 through 2014. ACS-NSQIP data were enhanced with additional variables from medical records. Multivariable logistic regression identified factors associated with SSI development.

Results

Of 2376 patients, 213 (9.0%) developed at least one SSI (superficial 4.8%, deep 1.1%, organ space 3.5%). Age < 40, BMI > 30, ASA3+, steroid use, smoking, diabetes, pre-operative sepsis, higher wound class, elevated WBC or serum glutamic-oxalocetic transaminase, low hematocrit or albumin, Crohn’s disease, and prolonged incision-to-closure time were associated with increased SSI rate (all P < 0.01). After adjustment, BMI > 30, steroids, diabetes, and wound contamination were associated with SSI. Patients with Crohn’s had greater odds of SSI than other indications.

Conclusion

Institutional modeling of SSI suggests that many previously suggested risk factors established on a national level do not contribute to SSIs at our institution. Identification of institution-specific predictors of SSI, rather than relying upon conclusions derived from external data, is a critical endeavor in facilitating quality improvement and maximizing value of quality investments.

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Acknowledgments

The authors gratefully acknowledge the support of the Mayo Clinic Department of Surgery and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery as substantial contributors of in-kind resources to the project. Diane Tyndale and Sharon Nehring, without whose dedication to this task, the project would not have been possible, have performed abstraction for our institutional NSQIP data in colon and rectal surgery for many years. Dr. Bergquist acknowledges the Mayo Clinic Clinician Investigator Training Program for salary support. Ms. Hanson, Drs. Thiels & Habermann receive and gratefully acknowledge salary support from the Surgical Outcomes Program in the Kern Center for the Science of Health Care Delivery at the Mayo Clinic.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Robert R. Cima, John R. Bergquist & Cornelius A. Thiels

  2. Surgical Outcomes Program, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA

    Robert R. Cima, John R. Bergquist, Kristine T. Hanson, Cornelius A. Thiels & Elizabeth B. Habermann

  3. Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Elizabeth B. Habermann

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  1. Robert R. Cima
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Correspondence to Robert R. Cima.

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Conflicts of Interest

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery provides salary support for Drs. Habermann/Thiels and Ms. Hanson and in kind material support for Dr. Bergquist and Dr. Thiels. Dr. Bergquist has received salary support from the Mayo Clinic Clinician Investigator Training program. These funding sources did not affect our investigation.

Sources of Funding

This work was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery.

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The authors had complete access to the study data supporting this manuscript.

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Cima, R.R., Bergquist, J.R., Hanson, K.T. et al. Outcomes are Local: Patient, Disease, and Procedure-Specific Risk Factors for Colorectal Surgical Site Infections from a Single Institution. J Gastrointest Surg 21, 1142–1152 (2017). https://doi.org/10.1007/s11605-017-3430-1

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