Factors impacting wound infection in colorectal surgery
Main Article Content
Abstract
Introduction: Surgical site infections (SSI's) are amongst the most common hospital acquired infections within surgical patients. It increases morbidity and healthcare costs. The aim of this project was to look at risk factors for surgical site infections.
Methods: Univariate analysis was done on the infected and non infected groups comparing variables that potentially contribute to surgical site infections. Multivariate analysis was then performed on each of the significant findings to ascertain if the results were still significant after adjusting for age, operative time and ASA scores. A p value of <0.05 was considered statistically significant.
Results: Forty-eight out of the 620 patients that underwent colorectal surgery during 2013 and 2014 had wound infections (7.7%). A statistically significant SSI association is seen for open surgery (OR 6.13, P= 0.003), emergency operations (OR 2.15, P=0.01), peritoneal contamination (OR 3, P=0.001), stoma formation (2.18, p= 0.01), closure with staples (OR 2.82, p=0.009) and closure with absorbable sutures (OR 0.18, p=0.001). Even though both staples and absorbable sutures were significantly associated with SSI's, the odds ratio was greater with staples. On multivariate analysis all of the above variables were independently associated with wound infection after adjusting for age, operative time and ASA.
Conclusion: The study shows that commonly accepted factors such as open surgery, contaminated abdominal cavities, emergency operation and stoma formation increase the likelihood of SSI’s. Using staples may also increase the likelihood of SSI’s compared to sutures.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
5. Centers for Disease Control and Prevention. The National Healthcare Safety Network (NHSN) Manual: Patient Safety Component. Atlanta, GA: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases. Available at: http://www.cdc.gov/nhsn/acute-care-hospital/index.html . (last accessed Feb 2015).
10. Connolly TM, Foppa C, Kazi E, Denoya PI, Bergamaschi R. Impact of surgical site infection reduction strategy after colorectal resection. Colorectal Dis. 2015 Oct 12. [Epub ahead of print]
4. 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):387–397.
8. Diener MK, Knebel P, Kieser M, Schuler P, Schiergens TS, Atanassov V et al. Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial. Lancet 2014;384(9938):142–152.
19. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340:448–454.
11. Ghuman A, Chan T, Karimuddin AA, Brown CJ, Raval MJ, Phang PT. Dis Colon Rectum. Surgical Site Infection Rates Following Implementation of a Colorectal Closure Bundle in Elective Colorectal Surgeries. Dis Colon Rectum 2015 Nov;58(11):1078-82.
12. Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2003;(2):CD001544.
18. Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K. Risk factors for surgical site infection following colorectal resection: a multi-institutional study. Int J Colorectal Dis. 2015 Oct 28. [Epub ahead of print]
3. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20(11):725–730.
2. Mahmoud N.N., Turpin R.S., Yang G., Saunders W.B. Impact of surgical site infections on length of stay and costs in selected colorectal procedures. Surg Infect 2009; 10:539-544.
7. Mihaljevic AL, Schirren R, Ozer M, Ottl S, Grun S, Michalski CW et al. Multicenter double-blinded randomized controlled trial of standard abdominal wound edge protection with surgical dressingsversus coverage with a sterile circular polyethylene drape for prevention of surgical site infections: a CHIR-Net Trial (BaFO; NCT01181206). Ann Surg 2014;260(5):730–739.
15. Moghadamyeghaneh Z, Hanna MH, Carmichael JC, et al. Wound Disruption Following Colorectal Operations. World J Surg. 2015;39(12):2999-3007.
13. Nelson RL, Gladman E, Barbateskovic M. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev. 2014;(5):CD001181.
9. Pinkney TD, Calvert M, Bartlett DC, Gheorghe A, Redman V, Dowswell G et al. Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI Trial). BMJ 2013; 347:f4305.
16. Sorrentino M1, Brizzolari M, Scarpa E, et al. Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a definitive treatment? Retrospective analysis of 63 cases. Tech Coloproctol. 2015 Feb;19(2):105-10.
1. Tang R., Chen H.H., Wang Y.L., et al. Risk factors for surgical site infection after elective resection of the colon and rectum: a single centre prospective study of 2809 consecutive patients. Ann Surg, 2001; 234:181-189.
17. Tsujinaka T, Yamamoto K, Fujita J, Endo S, Kawada J, Nakahira Set al. Clinical Study Group of Osaka University on Section of RiskManagement. Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery: a phase 3, multicentre, open-label, randomised controlled trial. Lancet 2013;382:1105–1112.
6. Victorian Healthcare Associated Infection Surveillance System: Surgical site infection. Available:
14 Yamaoka Y, Ikeda M, Ikenaga M, et al. Efficacy of skin closure with subcuticular sutures for preventing wound infection after resection of colorectal cancer: a propensity score-matched analysis. Langenbecks Arch Surg. 2015 Oct 2. [Epub ahead of print]