Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections

Degrate, Luca; Garancini, Mattia; Misani, Marta; Poli, Silvia De; Nobili, Cinzia; Romano, Fabrizio; Giordano, Laura; Motta, Vittorio; Uggeri, Franco

doi:10.1007/s00384-010-1057-8

Cited by 50 publications

(31 citation statements)

References 32 publications

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“…Higher SSI proportions were reported after colon surgery with colostomy vs. no colostomy at a single hospital in Italy, (11) and left sided colectomy was independently associated with higher SSI risk compared to other colectomies in New York state hospitals. (12) Trans-tibial amputations had significantly higher 30-day deep incisional SSI risk than trans-femoral amputations in people ≥50 years old in a study by Hasanadka et al using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).…”

Section: Discussionmentioning

confidence: 99%

Procedure-specific surgical site infection incidence varies widely within certain National Healthcare Safety Network surgery groups

Saeed¹,

Dubberke²,

Fraser³

et al. 2015

American Journal of Infection Control

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Background The National Healthcare Safety Network (NHSN) classifies surgical procedures into 40 categories. The objective of this study was to determine surgical site infection (SSI) incidence for clinically defined subgroups within 5 heterogeneous NHSN surgery categories. Methods This is a retrospective cohort study using the longitudinal State Inpatient Database. We identified 5 groups of surgical procedures (amputation; biliary, liver and pancreas [BILI]; breast; colon and hernia) using ICD-9-CM procedure codes in community hospitals in California, Florida and New York from January 2009 through September 2011 in persons aged ≥18 years. Each of these 5 categories was classified to more specific surgical procedures within the group. 90-day SSI rates were calculated using ICD-9-CM diagnosis codes. Results There were 62,901 amputation, 33,358 BILI, 72,058 breast, 125,689 colon and 85,745 hernia surgeries in 349,298 people. 90-day SSI rates varied significantly within each of the 5 subgroups. Within the BILI category, bile duct, pancreas and laparoscopic liver procedures had SSI rates of 7.2%, 17.2%, and 2.2%, respectively (p<0.0001 for each) compared to open liver procedures (11.1% SSI). Conclusion 90-day SSI rates varied widely within certain NHSN categories. Risk adjustment for specific surgery type is needed in order to make valid comparisons between hospitals.

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Section: Discussionmentioning

confidence: 99%

Procedure-specific surgical site infection incidence varies widely within certain National Healthcare Safety Network surgery groups

Saeed¹,

Dubberke²,

Fraser³

et al. 2015

American Journal of Infection Control

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“…A study by Degratego et al on 277 patients separately investigated the post-operative follow-up after rectal resection and resection of the left and right sides of the colon. They found that SSI rates were twice higher in those after rectal resection compared to those after resection of the right side of the colon; 17.6% vs 8%, however SSI rates were similar when comparing left side colonic resection with rectal resection; 18.4% vs 17.6% [19]. Our SSI study was based on assessing SSI according to the European Commission definition which was adopted by general surgery specialists for patients treated in hospital or those observed within a specialist clinic.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for surgical site infections in rectal cancer patients

Banaszkiewicz

Tojek²,

Jarmocik³

et al. 2017

Nowotwory. Journal of Oncology

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Introduction. Rectal cancer surgery is associated with high rates of post-operative complications in which the most common are Surgical Site Infections (SSI). Materials and methods. Factors responsible for SSI incidence were retrospectively analysed in rectal cancer patients who had undergone surgery at a single centre for oncology between July 2012 and July 2016. The study end-point was patients' contracting SSI. Statistical analyses were performed by the 'Statistica 12' package consisting of the Pearson's Chi-squared test (χ 2 ), the Kruskal-Wallis test and the Mann-Whitney U-test (with continuity correction). Qualitative variables were analysed using log-linear analysis. The likelihoods of SSI incidence were compared by using odds ratios within 95% confidence limits. Results. Amongst the 187 patient subjects under observation during their 30 day follow-up, 44 (23.5%) suffered from post-operative complications of which SSI were the most common at 27 (14.4%). In those patients with advanced stage IV cancer, SSI occurred 3-fold more compared to patients with lower stage cancers; respectively 27.3% vs 11.7%, p = 0.021. Multivariate analysis demonstrated that the highest SSI risk was in patients having a low-lying tumour (≤ 5 cm from the anal rim; OR 2.31 (95% CI of 1.15 to 4.62), p = 0.019 and those patients who had undergone Hartmann's procedure; OR 1.85 (95% CI of 1.04 to 3.31), p = 0.038. Conclusions. Surgical site infections in rectal cancer patients undergoing surgery occur significantly more in those at advanced stage IV rectal cancer where the tumour is low-lying (0-5 cm from the anal rim) and after having undergone the Hartmann's procedure.

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“…Operating on the right colon presents a different infective morbidity compared to colectomies of the hindgut (28) but evidence regarding the combination of liver and colorectal surgery is missing. Our results imply that the addition of another procedure to hepatectomy has no effect on O/SI.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Organ/Space Infection after Radiofrequency-Assisted Hepatectomy or Ablation of Liver Tumors in a Single Center: More than Meets the Eye

et al. 2017

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IntroductionSurgical site infections (SSIs) and especially organ/space infection (O/SI) after resection or ablation of liver tumors are associated with increased morbidity and mortality. A secondary blood stream infection (BSI) is considered an O/SI but the exact prevalence is unknown. We aimed to investigate the incidence of O/SI and BSIs in a cohort of consecutive patients after liver resection or ablation, to seek for a possible connection between them and to search for potential risk factors.Materials and methodsWe reviewed all patients who underwent hepatic resection or intraoperative liver ablation between January 2012 and December 2016 in our department. We focused on age, gender, Child–Pugh score, preoperative biliary drainage, indication for surgery, type of resection, resection or ablation of tumor, need for bilioenteric reconstruction, additional procedure to hepatectomy, blood transfusion, operative time, postoperative admission to ICU, and antibiotic chemoprophylaxis. All positive cultures from intra-abdominal fluids and blood were recorded. O/SI and BSIs were diagnosed by the criteria set by Centers for Disease Control. All variables were compared between the group with O/SI and the group without infection. BSIs were associated with these infections also.ResultsEighty-one consecutive patients with a mean age of 64 years were enrolled. Fifteen patients presented a positive culture postoperatively: intra-abdominal fluid in eight, blood cultures in six, and both blood and intra-abdominal fluid in one patient. The directly estimated incidence of O/SI amounted to 11.1%. Four blood cultures were secondary to O/SI, and the remaining two secondary to central line catheter. O/SI was diagnosed indirectly, through the BSI in an additional 4.9% of the patients, raising the incidence of SSI to 16%. Among the factors studied, only admission to the ICU was found to be statistically significant as a risk factor for the development of O/SI (p = 0.026).ConclusionO/SI should be actively seeked for after liver surgery including blood cultures. Patients with affected physical status, comorbidities are in greater risk of developing O/SI.

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Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections

Abstract: SSI incidences, characteristics, and risk factors seem to be different among RCS, LCS, and RS. A tailored SSI surveillance program should be applied for each of the three groups, leading to a more competent SSI recognition and reduction of SSI incidence and related costs.

Cited by 50 publications

References 32 publications

Procedure-specific surgical site infection incidence varies widely within certain National Healthcare Safety Network surgery groups

Procedure-specific surgical site infection incidence varies widely within certain National Healthcare Safety Network surgery groups

Risk factors for surgical site infections in rectal cancer patients

Incidence and Risk Factors for Organ/Space Infection after Radiofrequency-Assisted Hepatectomy or Ablation of Liver Tumors in a Single Center: More than Meets the Eye

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