Elsevier

Surgery

Volume 142, Issue 5, November 2007, Pages 704-711
Surgery

Original communication
Surgical site infections after colorectal surgery: Do risk factors vary depending on the type of infection considered?

https://doi.org/10.1016/j.surg.2007.05.012Get rights and content

Background

The purpose of this study was to compare risk factors for the development of incisional versus organ/space infections in patients undergoing colorectal surgery.

Methods

An institutional review board–approved retrospective review was performed examining a 4-year period (January 2002 to December 2005). Patients were included if they had undergone abdominal operations (open or laparoscopic) in which the colon/rectum was surgically manipulated. Patients were excluded if the surgical wound was not closed primarily. A standardized definition of incisional and organ/space infection was employed.

Results

A total of 428 operations were performed. Overall, 105 infections were identified (25%); 73 involved the incision and 32 were classified as organ/space. Multivariate analysis suggested that incisional infection was independently associated with body mass index (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.02-1.11) and creation/revision/reversal of an ostomy (OR, 2.2; 95% CI, 1.3-3.9). Organ/space infection was independently associated with perioperative transfusion (OR, 2.3; 95% CI, 1.1-5.5) and with previous abdominal surgery (OR, 2.5; 95% CI, 1.2-5.3).

Conclusions

Factors associated with infection differed based on the type of surgical site infection being considered. The lack of overlap between factors associated with incisional infection and organ/space infection suggests that separate risk models and treatment strategies should be developed.

Section snippets

Materials and methods

An institutional review board–approved retrospective review of all patients undergoing colorectal operations at a single tertiary care institution was performed. The period of time reviewed extended from January 1, 2002 to December 31, 2005. Information was gathered from a number of sources to ensure completeness of the data included in this study. A prospective database maintained by nurses in our Infection Control Program was used as the primary source of information concerning infections.

Results

A total of 428 patients met the inclusion criteria for this study. There were 417 male and 11 female patients. The median age for the cohort was 64 years (range, 26-90). Table I, Table II provide an overview of the demographic, clinical, and perioperative information for this cohort of patients.

A total of 105 SSIs were identified among these 428 patients (overall SSI rate, 24.5%). Seventy-three incisional infections (70% of all infections; 18% of those at risk) were identified and 32

Discussion

The rate of SSIs reported for colorectal surgery has varied between 5% and 26%.4, 5, 6, 7, 8, 11 Most of this variation is probably a function of multiple definitions of SSI, differing personnel performing the assessments for infection (infection control nurse vs surgeon), various time periods for assessment (14 vs 30 days), inclusion of all procedures versus selected ones, and the inclusion of infections identified after discharge. The present study attempted to address all these potential

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