Background. The purpose of this study was to clarify the incidence and risk factors for incisional surgical site infections (SSI) in patients undergoing elective open surgery for colorectal cancer. Methods. We conducted prospective surveillance of incisional SSI after elective colorectal resections performed by a single surgeon for a 1-year period. Variables associated with infection, as identified in the literature, were collected and statistically analyzed for their association with incisional SSI development. Results. A total of 224 patients were identified for evaluation. The mean patient age was 67 years, and 120 (55%) were male. Thirty-three (14.7%) patients were diagnosed with incisional SSI. Multivariate analysis suggested that incisional SSI was independently associated with TNM stages III and IV (odds ratio [OR], 2.4) and intraoperative hypotension (OR, 3.4). Conclusions. The incidence of incisional SSI in our cohort was well within values generally reported in the literature. Our data suggest the importance of the maintenance of intraoperative normotension to reduce the development of incisional SSI. 1. Introduction Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, contributing to perioperative morbidity, prolonged postoperative hospital length of stay, and increased hospital costs [1–3]. The colorectal surgery has been associated with the highest risk of SSI [1], predominately because of the heavy bacterial load of the colon and rectum. The incidence of incisional SSI following colorectal surgery has been reported to range from 5% to 26% [4–8]. Although various risk factors for incisional SSI have been reported [1, 4–6], there has been no clear consensus on the risk factors contributing to incisional SSI following colorectal surgery. To clarify the incidence and risk factors for incisional SSI, we conducted prospective surveillance of incisional SSI and analyzed plausible factors in patients undergoing elective open surgery for colorectal cancer, performed by a single surgeon. 2. Materials and Methods 2.1. Subjects This prospective observational study was conducted at Keiyukai Sapporo Hospital from January 1, 2009, to December 31, 2009. All patients undergoing elective laparotomy with colorectal resection for cancer by a single board-certified colon and rectal surgeon (Takaya Kusumi) were registered in this cohort. Patients were excluded if the surgical wound was not closed primarily. Also excluded were patients undergoing laparoscopy or simple ostomy creation or closure with associated wedge or
References
[1]
National Nosocomial Infections Surveillance System, “National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004,” The American Journal of Infection Control, vol. 32, no. 8, pp. 470–485, 2004.
[2]
A. J. Mangram, T. C. Horan, M. L. Pearson, L. C. Silver, and W. R. Jarvis, “Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee,” The American Journal of Infection Control, vol. 27, no. 2, pp. 97–132, 1999.
[3]
T. Anthony, J. Long, L. S. Hynan et al., “Surgical complications exert a lasting effect on disease-specific health-related quality of life for patients with colorectal cancer,” Surgery, vol. 134, no. 2, pp. 119–125, 2003.
[4]
R. L. Smith, J. K. Bohl, S. T. McElearney et al., “Wound Infection after elective colorectal resection,” Annals of Surgery, vol. 239, no. 5, pp. 599–607, 2004.
[5]
R. Tang, H. H. Chen, Y. L. Wang et al., “Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients,” Annals of Surgery, vol. 234, no. 2, pp. 181–189, 2001.
[6]
T. Konishi, T. Watanabe, J. Kishimoto, and H. Nagawa, “Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance,” Annals of Surgery, vol. 244, no. 5, pp. 758–763, 2006.
[7]
T. Nakamura, H. Mitomi, A. Ihara et al., “Risk factors for wound infection after surgery for colorectal cancer,” World Journal of Surgery, vol. 32, no. 6, pp. 1138–1141, 2008.
[8]
M. Kobayashi, Y. Mohri, Y. Inoue, Y. Okita, C. Miki, and M. Kusunoki, “Continuous follow-up of surgical site infections for 30 days after colorectal surgery,” World Journal of Surgery, vol. 32, no. 6, pp. 1142–1146, 2008.
[9]
F. M. Steichen, “The use of staplers in anatomical side-to-side and functional end-to-end enteroanastomoses,” Surgery, vol. 64, no. 5, pp. 948–953, 1968.
[10]
J. W. Baker, “Low end to side rectosigmoidal anastomosis; description of technic,” Archives of Surgery, vol. 61, no. 1, pp. 143–157, 1950.
[11]
C. D. Knight and F. D. Griffen, “An improved technique for low anterior resection of the rectum using the EEA stapler,” Surgery, vol. 88, no. 5, pp. 710–714, 1980.
[12]
Z. Cohen, E. Myers, B. Langer, B. Taylor, R. H. Railton, and C. Jamieson, “Double stapling technique for low anterior resection,” Diseases of the Colon & Rectum, vol. 26, no. 4, pp. 231–235, 1983.
[13]
T. Horiuchi, H. Tanishima, K. Tamagawa et al., “Randomized, controlled investigation of the anti-infective properties of the Alexis retractor/protector of incision sites,” The Journal of Trauma—Injury, Infection and Critical Care, vol. 62, no. 1, pp. 212–215, 2007.
[14]
C. R. Cervantes-Sánchez, R. Gutiérrez-Vega, J. A. Vázquez-Carpizo, P. Clark, and C. Athié-Gutiérrez, “Syringe pressure irrigation of subdermic tissue after appendectomy to decrease the incidence of postoperative wound infection,” World Journal of Surgery, vol. 24, no. 1, pp. 38–42, 2000.
[15]
E. Kaya, E. Paksoy, E. Ozturk, D. Sigirli, and H. Bilgel, “Subcutaneous closed-suction drainage does not affect surgical site infection rate following elective abdominal operations: a prospective randomized clinical trial,” Acta Chirurgica Belgica, vol. 110, no. 4, pp. 457–462, 2010.
[16]
J. Blumetti, M. Luu, G. Sarosi et al., “Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered?” Surgery, vol. 142, no. 5, pp. 704–711, 2007.
[17]
K. M. F. Itani, S. E. Wilson, S. S. Awad, E. H. Jensen, T. S. Finn, and M. A. Abramson, “Ertapenem versus cefotetan prophylaxis in elective colorectal surgery,” The New England Journal of Medicine, vol. 355, no. 25, pp. 2640–2651, 2006.
[18]
E. C. Vamvakas, J. H. Carven, and P. L. Hibberd, “Blood transfusion and infection after colorectal cancer surgery,” Transfusion, vol. 36, no. 11-12, pp. 1000–1008, 1996.
[19]
A. M. Glenny and F. Song, “Antimicrobial prophylaxis in colorectal surgery,” Quality in Health Care, vol. 8, no. 2, pp. 132–136, 1999.
[20]
D. W. Bratzler and D. R. Hunt, “The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery,” Clinical Infectious Diseases, vol. 43, no. 3, pp. 322–330, 2006.
[21]
W. P. Weber, W. R. Marti, M. Zwahlen et al., “The timing of surgical antimicrobial prophylaxis,” Annals of Surgery, vol. 247, no. 6, pp. 918–926, 2008.
[22]
K. B. Kirkland, J. P. Briggs, S. L. Trivette, W. E. Wilkinson, and D. J. Sexton, “The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs,” Infection Control and Hospital Epidemiology, vol. 20, no. 11, pp. 725–730, 1999.
