Abstract
Purpose
Surgical site infection (SSI) is the most common complication following surgical procedures. This study aimed to determine risk factors associated with SSI in patients with Crohn’s disease (CD) complicated with gastrointestinal fistula.
Methods
This was a retrospective review of patients who underwent surgical resection in gastrointestinal fistula patients with CD between January 2013 and January 2015, identified from a prospectively maintained gastrointestinal fistula database. Demographic information, preoperative medication, intraoperative findings, and postoperative outcome data were collected. Univariate and multivariate analysis was carried out to assess possible risk factors for SSI.
Results
A total of 118 patients were identified, of whom 75.4% were men, the average age of the patients was 34.1 years, and the average body mass index (BMI) was 18.8 kg/m2. The rate of SSI was 31.4%. On multivariate analysis, preoperative anemia (P = 0.001, OR 7.698, 95% CI 2.273–26.075), preoperative bacteria present in fistula tract (P = 0.029, OR 3.399, 95% CI 1.131–10.220), and preoperative enteral nutrition (EN) <3 months (P < 0.001, OR 11.531, 95% CI 3.086–43.079) were predictors of SSI. Notably, preoperative percutaneous abscess drainage was shown to exert protection against SSI in fistulizing CD (P = 0.037, OR 0.258, 95% CI 0.073–0.920).
Conclusion
Preoperative anemia, bacteria present in fistula tract, and preoperative EN <3 months significantly increased the risk of postoperative SSI in gastrointestinal fistula complicated with CD. Preoperative identification of these risk factors may assist in risk assessment and then to optimize preoperative preparation and perioperative care.
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References
Schwartz DA, Loftus EV Jr, Tremaine WJ et al (2002) The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology 122(4):875–880
Molendijk I, Peeters KC, Baeten CI et al (2014) Improving the outcome of fistulising Crohn’s disease. Best Pract Res Clin Gastroenterol 28(3):505–518
Haane C, Krummenerl T, Matuszewski L et al (2013) Fatal complications in fistulizing Crohn’s disease: brain abscess and squamous cell carcinoma. Int J Color Dis 28(8):1171–1173
Bell SJ, Williams AB, Wiesel P et al (2003) The clinical course of fistulating Crohn’s disease. Aliment Pharmacol Ther 17(9):1145–1151
Cosnes J, Gower-Rousseau C, Seksik P et al (2011) Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 140(6):1785–1794
Gionchetti P, Dignass A, Danese S, et al. (2016) 3. EUROPEAN Evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 2: Surgical management and special situations. J Crohns Colitis
Bhakta A, Tafen M, Glotzer O et al (2016) Increased incidence of surgical site infection in IBD patients. Dis Colon rectum 59(4):316–322
El-Asmar K, El-Shafei E, Abdel-Latif M et al (2016) Surgical aspects of inflammatory bowel diseases in pediatric and adolescent age groups. Int J Color Dis 31(2):301–305
Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20(4):250–278 quiz 279-280
Yamamoto T, Allan RN, Keighley MR (2000) Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum 43(8):1141–1145
Kanazawa A, Yamana T, Okamoto K et al (2012) Risk factors for postoperative intra-abdominal septic complications after bowel resection in patients with Crohn’s disease. Dis Colon Rectum 55(9):957–962
Bellolio F, Cohen Z, Macrae HM et al (2013) Outcomes following surgery for perforating Crohn’s disease. Br J Surg 100(10):1344–1348
Wu X, Ren J, Wang G et al (2015) Colonization of Klebsiella pneumoniae inside fistula tracts: a possible risk factor for failure of fibrin glue-assisted closure. J Clin Gastroenterol 49(4):293–299
Fan YP, Ren JA, Zhao YZ et al (2014) Fistula output microorganism-susceptible antimicrobial prophylaxis is associated with a lower risk of surgical site infection in gastrointestinal fistula patients undergoing one-stage definitive surgery. Surg Infect 15(6):774–780
Uchino M, Ikeuchi H, Tsuchida T et al (2009) Surgical site infection following surgery for inflammatory bowel disease in patients with clean-contaminated wounds. World J Surg 33(5):1042–1048
Uchino M, Ikeuchi H, Matsuoka H et al (2013) Risk factors for surgical site infection and association with infliximab administration during surgery for Crohn’s disease. Dis Colon Rectum 56(10):1156–1165
Serradori T, Germain A, Scherrer ML et al (2013) The effect of immune therapy on surgical site infection following Crohn’s disease resection. Br J Surg 100(8):1089–1093
Claesson BE, Holmlund DE (1988) Predictors of intraoperative bacterial contamination and postoperative infection in elective colorectal surgery. J Hosp Infect 11(2):127–135
Belda J, Cavalcanti M, Ferrer M et al (2005) Bronchial colonization and postoperative respiratory infections in patients undergoing lung cancer surgery. Chest 128(3):1571–1579
Filmann N, Rey J, Schneeweiss S et al (2014) Prevalence of anemia in inflammatory bowel diseases in European countries: a systematic review and individual patient data meta-analysis. Inflamm Bowel Dis 20(5):936–945
Koutroubakis IE, Ramos-Rivers C, Regueiro M et al (2015) Persistent or recurrent anemia is associated with severe and disabling inflammatory bowel disease. Clin Gastroenterol Hepatol 13(10):1760–1766
Bruewer M, Utech M, Rijcken EJ et al (2003) Preoperative steroid administration: effect on morbidity among patients undergoing intestinal bowel resection for Crohns disease. World J Surg 27(12):1306–1310
Heimann TM, Greenstein AJ, Mechanic L et al (1985) Early complications following surgical treatment for Crohn’s disease. Ann Surg 201(4):494–498
Yang SS, Yu CS, Yoon YS et al (2012) Risk factors for complications after bowel surgery in Korean patients with Crohn’s disease. J Korean Surg Soc 83(3):141–148
Alves A, Panis Y, Bouhnik Y et al (2007) Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn’s disease: a multivariate analysis in 161 consecutive patients. Dis Colon Rectum 50(3):331–336
Smedh K, Andersson M, Johansson H et al (2002) Preoperative management is more important than choice of sutured or stapled anastomosis in Crohn’s disease. Eur J Surg 168(3):154–157
Li G, Ren J, Wang G et al (2014) Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn’s disease. Eur J Clin Nutr 68(4):441–446
Lobaton T, Guardiola J, Rodriguez-Moranta F et al (2013) Comparison of the long-term outcome of two therapeutic strategies for the management of abdominal abscess complicating Crohn’s disease: percutaneous drainage or immediate surgical treatment. Color Dis 15(10):1267–1272
Zhu W, Li Y, Gong J et al (2015) Tripterygium wilfordii Hook. f. versus azathioprine for prevention of postoperative recurrence in patients with Crohn’s disease: a randomized clinical trial. Dig Liver Dis 47(1):14–19
Muller-Wille R, Iesalnieks I, Dornia C et al (2011) Influence of percutaneous abscess drainage on severe postoperative septic complications in patients with Crohn’s disease. Int J Color Dis 26(6):769–774
Ali T, Yun L, Rubin DT (2012) Risk of post-operative complications associated with anti-TNF therapy in inflammatory bowel disease. World J Gastroenterol 18(3):197–204
Lau C, Dubinsky M, Melmed G et al (2015) The impact of preoperative serum anti-TNFalpha therapy levels on early postoperative outcomes in inflammatory bowel disease surgery. Ann Surg 261(3):487–496
Morar PS, Hodgkinson JD, Thalayasingam S et al (2015) Determining predictors for intra-abdominal septic complications following ileocolonic resection for Crohn’s disease—considerations in pre-operative and peri-operative optimisation techniques to improve outcome. J Crohns Colitis 9(6):483–491
Li Y, Zuo L, Zhu W et al (2015) Role of exclusive enteral nutrition in the preoperative optimization of patients with Crohn’s disease following immunosuppressive therapy. Medicine (Baltimore) 94(5):e478
Hu D, Ren J, Wang G et al (2014) Exclusive enteral nutritional therapy can relieve inflammatory bowel stricture in Crohn’s disease. J Clin Gastroenterol 48(9):790–795
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The Institutional Review Board of Jinling Hospital approved the project.
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This study was supported by grants from the National Natural Science Foundation of China (81571881).
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Guo, K., Ren, J., Li, G. et al. Risk factors of surgical site infections in patients with Crohn’s disease complicated with gastrointestinal fistula. Int J Colorectal Dis 32, 635–643 (2017). https://doi.org/10.1007/s00384-017-2751-6
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DOI: https://doi.org/10.1007/s00384-017-2751-6