Abstract

Background and objective: Surgical Site Infection (SSI) is one of the most common and expensive forms of hospital acquired infection, and is frequent after colorectal surgery. The objective of this study was to evaluate the association between several risk factors and SSI in adult patients undergoing colorectal surgery.

Methods: A retrospective cohort study was conducted using data from the 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Adults undergoing laparoscopic colectomy were included. A set of 12 potential risk factors was evaluated. The outcome was SSI, defined as superficial, deep-incisional, or organ-space infection. Logistic regression was used to assess the independent association between each potential risk factor and SSI.

Results: Of the 25,540 cases included, 1,478 developed SSI. Risk factors independently associated with SSI included obese category I (AOR 1.38; 95% CI 1.17 - 1.64), obese category II (AOR 1.52; 95% CI 1.24 - 1.86), obese category III (AOR 1.88; 95% CI 1.50 - 2.36), smoking (AOR 1.27; 95% CI 1.10 - 1.46), cancer (AOR 1.45; 95% CI 1.11 - 1.89), steroid use (AOR 1.38; 95% CI 1.15 - 1.66), dirty/infected wound class (AOR 2.65; 95% CI 1.40 - 4.99), undergoing emergency surgery (AOR 2.47; 95% CI 1.90 - 3.20), and operation time (AOR 1.00 for every 1 minute increase in operational time; 95% CI 1.00 - 1.00). Age (AOR 0.99 for every year that the patient is older; 95% CI 0.99 - 1.00) was the only protective factor against postoperative SSI. Patients undergoing emergency surgery, those classified as obesity category III, and those with dirty/infected wounds had the highest odds of SSI.

Conclusions: Patients undergoing laparoscopic colectomy may have modifiable and unmodifiable risk factors that put them at increased risk for developing SSI. Further research should be conducted on the role of preoperative initiatives including smoking cessation and weight control in decreasing the risk of SSI.