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Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis
Patrick Pessaux1, Simon Msika, David Atalla
1Service de Chirurgie Digestive, Centre Hospitalier et Universitaire Angers, Angers, France. pessauxpchuangers@Yahoo.fr
Hypothesis:
Infectious complications are the main causes of postoperative morbidity in abdominal surgery. Identification of risk factors, which could be avoided in the perioperative period, may reduce the rate of postoperative infectious complications.
Design:
A database was established from 3 prospective, randomized, multicenter studies. Multivariate analysis was performed using nonconditional logistic regression expressed as an odds ratio (OR).
Setting:
Multicenter studies (ie, private medical centers, institutional hospitals, and university hospitals).
Patients:
From June 1982 to September 1996, a database was established containing the information of 4718 patients who underwent noncolorectal abdominal surgery.
Main Outcome Measures:
The dependent variables studied included surgical site infection (SSI) (divided into parietal and deep infectious complications with or without fistulas) and global infectious complications (SSI and extraparietal and abdominal infectious complications).
Results:
The rate of global infectious complications was 13.3%; SSI, 4.05%; parietal infectious complications, 2.2%; deep infectious complications with fistulas, 2.18%; and deep infectious complications without fistulas, 1.38%. In multivariate analysis, the following 7 independent risk factors for global infectious complications have been identified: age (60-74 years, OR, 1.64; >or=75 years, OR, 1.45); being underweight (OR, 1.51); having cirrhosis (OR, 2.45), having a vertical abdominal incision (OR, 1.66); having a suture placed or an anastomis of the bowel (OR, 1.48) in the digestive tract; having a prolonged operative time (61-120 minutes, OR, 1.66; 121 minutes, OR, 2.72); and being categorized as having a class 4 surgical site (ie, obese patients or having a risk factor of a healing defect) (OR, 1.66). Ceftriaxone sodium therapy was identified as a protective factor (OR, 0.43). In multivariate analysis, the following 5 independent risk factors for SSI have been identified: the existence of a preoperative cutaneous abscess or cutaneous necrosis (OR, 4.75), having a suture placed or an anastomosis of the bowel (OR, 1.82) in the digestive tract, having postoperative abdominal drainage (OR, 2.15), undergoing a surgical procedure for the treatment of cancer (OR, 1.74), and receiving curative anticoagulant therapy (OR, 3.33) postoperatively.
Conclusions:
Our data show that risk factors for SSI and for global infectious complications are disparate. Indeed, only the placement of a suture or having an anastomosis of the bowel in the digestive tract is a risk factor for both SSI and global infections. Some of these factors may be modifiable before or during the surgical procedure to reduce the infection rate or to prevent postoperative complications.
Insights
Identifying modifiable risk factors for infectious complications after abdominal surgery is crucial. Factors like age, underweight status, cirrhosis, vertical incisions, bowel anastomosis, prolonged operative time, and high surgical site class increase risks, while ceftriaxone sodium therapy offers protection.
Area of Science:
- Surgery
- Infectious Diseases
- Epidemiology
Background:
- Infectious complications significantly contribute to postoperative morbidity in abdominal surgery.
- Identifying and mitigating perioperative risk factors can reduce the incidence of these complications.
Purpose of the Study:
- To identify independent risk factors for global infectious complications and surgical site infections (SSI) following noncolorectal abdominal surgery.
- To determine if identified risk factors are modifiable to prevent postoperative infectious complications.
Main Methods:
- Analysis of data from 4,718 patients across 3 prospective, randomized, multicenter studies.
- Multivariate logistic regression was used to identify independent risk factors and protective factors for infectious complications.
Main Results:
- Global infectious complications occurred in 13.3% of patients; SSI in 4.05%.
- Independent risk factors for global infections included advanced age, underweight status, cirrhosis, vertical incisions, bowel anastomosis, prolonged operative time, and surgical site class 4.
- Independent risk factors for SSI included preoperative cutaneous abscess/necrosis, bowel anastomosis, postoperative abdominal drainage, cancer surgery, and postoperative anticoagulant therapy.
Conclusions:
- Risk factors for SSI and global infectious complications are largely distinct, with bowel anastomosis being a common risk factor.
- Several identified risk factors are potentially modifiable, offering opportunities to reduce postoperative infectious complications.
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