Risk Factors for Surgical Site Infection After Laparoscopic Colectomy: An NSQIP Database Analysis

Nasser, Hassan; Ivanics, Tommy; Leonard-Murali, Shravan; Stefanou, Amalia

doi:10.1016/j.jss.2019.12.021

Cited by 21 publications

(23 citation statements)

References 36 publications

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“…In contrast with previous research (15)(16)(17), intraoperative blood loss > 500 ml was not significantly associated with postoperative organ/space SSI, which may be due to the prevalence of bloodless surgery. Other risk factors for SSI in previous studies, such as diabetes or perioperative hyperglycemia, obesity, low preoperative albumin and an immunosuppressive status (4,6,(18)(19)(20), did not show any significant relationship with organ/space SSI in our results either. One possible reason is that diabetes and obesity may be more related to superficial SSI than to organ/space SSI.…”

Section: Discussioncontrasting

confidence: 83%

Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

et al. 2021

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BackgroundOrgan/space surgical site infection (organ/space SSI) is a serious postoperative complication, closely related to a poor prognosis. Few studies have attempted to stratify the risk of organ/space SSI for patients with advanced digestive system cancer. This study aimed to identify a simple risk stratification for these patients based on perioperative factors.MethodsThe study was based on two randomized controlled trials (RCT) (NCT02715076, ChiCTR-IPR-17011099), including 839 patients undergoing elective radical resection of advanced digestive system cancer. The primary outcome was organ/space SSI within 30 days after surgery. Multivariable logistic regression model was used to identify risk factors. The risk of organ/space SSI stratified over those risk factors was compared using chi-square tests and the relative risk (RR) was estimated.ResultsAmong the 839 patients, 51 developed organ/space SSI (6.1%) within 30 days after surgery. According to the multivariable logistic regression model, 3 procedure types, including gastrectomy (OR=8.22, 95% CI: 2.71-24.87, P<0.001), colorectal resection (OR=8.65, 95% CI: 3.13-23.85, P<0.001) and pancreatoduodenectomy (OR=7.72, 95% CI: 2.95-20.21, P<0.001), as well as anaesthesia time > 4 h (OR=2.38, 95% CI: 1.08-5.27, P=0.032) and prolonged ICU stay (OR=4.10, 95% CI: 1.67-10.10, P=0.002), were risk factors for postoperative organ/space SSI. The number of risk factors was significantly associated with an increased risk of organ/space SSI (P<0.001), which was 2.8% in patients with 0-1 risk factor (RR=0.20, 95% CI: 0.11-0.35), 13.0% in patients with 2 risk factors (RR=3.64, 95% CI: 2.14-6.20) and 35.7% in patients with 3 risk factors (RR=6.41, 95% CI: 3.01-13.65).ConclusionThis study is a preliminary exploratory and provides a simple risk stratification to identify the risk of postoperative organ/space SSI for patients with advanced digestive system cancer. Further research is needed to validate and generalize the results in a wider population.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT02715076; Chinese Clinical Trial Registry [https://www.chictr.org.cn/enindex.aspx], identifier ChiCTR-IPR-17011099.

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Section: Discussioncontrasting

confidence: 83%

Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

et al. 2021

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“…Cigarette smoking can delay wound healing, even for a minor and clean wound, thereby increasing the risk of SSI [ 8 , 33 , 36 , 60 ]. This study found that the smokers had a 1.38-fold increased risk of developing SSI in comparison with the nonsmokers, which was consistent with the NNIS guidelines [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

“…In general, the patients undergoing surgery, particularly those who undergo surgery for colorectal diseases, are more likely to develop SSI [ 6 , 7 ]. Although their etiology is multifactorial, the majority of SSIs are preventable [ 8 ]. Multiple factors can affect the development of SSI, including patient-related factors (such as obesity, diabetes mellitus, age, gender, and smoking) and treatment-related factors (such as laparoscopic procedure, prophylactic antibiotics, and stoma creation) [ 5 , 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although their etiology is multifactorial, the majority of SSIs are preventable [ 8 ]. Multiple factors can affect the development of SSI, including patient-related factors (such as obesity, diabetes mellitus, age, gender, and smoking) and treatment-related factors (such as laparoscopic procedure, prophylactic antibiotics, and stoma creation) [ 5 , 8 – 10 ]. Unsatisfactorily, few risk factors are generally accepted and some findings on these factors in medical literature are often contradictory.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for surgical site infection in patients undergoing colorectal surgery: A meta-analysis of observational studies

Qü

Gong

et al. 2021

PLoS ONE

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Objective Surgical site infection (SSI) is the second most prevalent hospital-based infection and affects the surgical therapeutic outcomes. However, the factors of SSI are not uniform. The main purpose of this study was to understand the risk factors for the different types of SSI in patients undergoing colorectal surgery (CRS). Methods PubMed, EMBASE, and Cochrane Library databases were searched using the relevant search terms. The data extraction was independently performed by two investigators using a standardized format, following the pre-agreed criteria. Meta-analysis for the risk factors of SSI in CRS patients was carried out using Review Manager 5.3 (RevMan 5.3) and Stata 15.1 software. The quality of evidence was evaluated using total sample size, Egger’s P-value, and intergroup heterogeneity, which contained three levels: high-quality (Class I), moderate-quality (Class II/III), and low-quality (Class IV). The publication bias of the included studies was assessed using funnel plots, Begg’s test, and Egger’s test. Results Of the 2660 potentially eligible studies, a total of 31 studies (22 retrospective and 9 prospective cohort studies) were included in the final analysis. Eventually, the high-quality evidence confirmed that SSI was correlated with obesity (RR = 1.60, 95% confidence interval (CI): 1.47–1.74), ASA score ≥3 (RR = 1.34, 95% CI: 1.19–1.51), and emergent surgery (RR = 1.36, 95% CI: 1.19–1.55). The moderate-quality evidence showed the correlation of SSI with male sex (RR = 1.30, 95% CI: 1.14–1.49), diabetes mellitus (RR = 1.65, 95% CI: 1.24–2.20), inflammatory bowel disease (RR = 2.12, 95% CI: 1.24–3.61), wound classification >2 (RR = 2.65, 95% CI: 1.52–4.61), surgery duration ≥180 min (RR = 1.88, 95% CI: 1.49–2.36), cigarette smoking (RR = 1.38, 95% CI: 1.14–1.67), open surgery (RR = 1.81, 95% CI: 1.57–2.10), stoma formation (RR = 1.89, 95% CI: 1.28–2.78), and blood transfusion (RR = 2.03, 95% CI:1.34–3.06). Moderate-quality evidence suggested no association with respiratory comorbidity (RR = 2.62, 95% CI:0.84–8.13) and neoplasm (RR = 1.24, 95% CI:0.58–2.26). Meanwhile, the moderate-quality evidence showed that the obesity (RR = 1.28, 95% CI: 1.24–1.32) and blood transfusion (RR = 2.32, 95% CI: 1.26–4.29) were independent risk factors for organ/space SSI (OS-SSI). The high-quality evidence showed that no correlation of OS-SSI with ASA score ≥3 and stoma formation. Furthermore, the moderate-quality evidence showed that no association of OS-SSI with open surgery (RR = 1.37, 95% CI: 0.62–3.04). The high-quality evidence demonstrated that I-SSI was correlated with stoma formation (RR = 2.55, 95% CI: 1.87–3.47). There were some certain publication bias in 2 parameters based on asymmetric graphs, including diabetes mellitus and wound classification >2. The situation was corrected using the trim and fill method. Conclusions The understanding of these factors might make it possible to detect and treat the different types of SSI more effectively in the earlier phase and might even improve the patient’s clinical prognosis. Evidence should be continuously followed up and updated, eliminating the potential publication bias. In the future, additional high-level evidence is required to verify these findings.

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“…Rather than diabetes per se, this may be more closely connected to the fact that what really predisposes patients to suffer infections is poor glycemic control of the disease; however, on not having access to the blood glucose levels of these patients, we have no way of confirming their baseline status for the purpose of establishing such an association 37,38 . Laparoscopic surgery happened to be a protective factor against SSI, as described in the literature 39,40 .…”

Section: Discussionmentioning

confidence: 96%

Effect of a Surgical Care Bundle on the Incidence of Surgical Site Infection in Colorectal Surgery: A Quasi-Experimental Intervention

Zarain-Obrador¹,

Alonso-García²,

Gil-Yonte³

et al. 2021

RIC

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Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant. (REV INVEST CLIN. [AHEAD OF PRINT]

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Risk Factors for Surgical Site Infection After Laparoscopic Colectomy: An NSQIP Database Analysis

Cited by 21 publications

References 36 publications

Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

Risk factors for surgical site infection in patients undergoing colorectal surgery: A meta-analysis of observational studies

Effect of a Surgical Care Bundle on the Incidence of Surgical Site Infection in Colorectal Surgery: A Quasi-Experimental Intervention

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