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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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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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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Abbreviations

ASA:

American Society of Anesthesia

APR:

Abdominoperineal resection

BMI:

Body mass index

CDC:

The Centers for Disease and Control

CI:

Confidence interval

COPD:

Chronic obstructive pulmonary disease

CT:

Computed tomography

HAR:

High anterior resection

ISR:

Internal sphincter resection

I-SSI:

Incisional surgical site infection

LAR:

Low anterior resection

LHC:

Left hemicolectomy

OR:

Odds ratio

RCT:

Randomized control trial

RHC:

Right hemicolectomy

SSI:

Surgical site infection

Sig:

Sigmoidectomy

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Acknowledgments

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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Authors and Affiliations

  1. The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan

    Keita Itatsu, Gen Sugawara, Yukihiro Yokoyama & Masato Nagino

  2. The Division of Surgical Infection, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Keita Itatsu & Gen Sugawara

  3. Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan

    Yuji Kaneoka

  4. Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan

    Takehito Kato

  5. Department of General Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan

    Eiji Takeuchi

  6. Department of Surgery, Kasugai Municipal Hospital, Kasugai, Japan

    Michio Kanai

  7. Department of General Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan

    Hiroshi Hasegawa

  8. Department of General Surgery, Anjo Kosei Hospital, Anjo, Japan

    Toshiyuki Arai

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  1. Keita Itatsu
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  2. Gen Sugawara
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  3. Yuji Kaneoka
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  4. Takehito Kato
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  5. Eiji Takeuchi
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  6. Michio Kanai
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  9. Yukihiro Yokoyama
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  10. Masato Nagino
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Corresponding author

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). https://doi.org/10.1007/s00595-013-0677-3

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  • DOI: https://doi.org/10.1007/s00595-013-0677-3

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