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Surgical site infection after stoma closure in children: outcomes and predictors
Dani O Gonzalez1, Erica Ambeba1, Peter C Minneci2
1Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Surgical site infections (SSI) after stoma closure in children are linked to longer operation times, patient age, Hirschsprung disease, and cardiac issues. Identifying these risk factors can help reduce SSI incidence.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Clinical Outcomes Research
Background:
- Surgical site infection (SSI) is a significant complication following intestinal stoma closure in children.
- Reported SSI rates after stoma closure vary widely, ranging from 0% to 40%.
Purpose of the Study:
- To identify demographic and clinical risk factors associated with SSI in pediatric patients undergoing stoma closure.
- To determine predictors of SSI to inform preventative strategies.
Main Methods:
- Utilized the 2012-2014 NSQIP Pediatric database to identify patients aged 0-18 years undergoing stoma closure.
- Compared demographic, clinical, and 30-day outcome characteristics between children with and without SSI.
- Employed multivariable logistic regression to identify independent predictors of SSI.
Main Results:
- Out of 2110 children, 7.6% developed SSI.
- Patients with SSI experienced significantly longer operating room times, anesthesia durations, total operation times, and hospital stays.
- Independent predictors of SSI included patient age, cardiac risk factors, Hirschsprung disease, and operation time exceeding 105 minutes.
Conclusions:
- Longer operation time, younger age, Hirschsprung disease, and cardiac risk factors are independently associated with increased SSI risk after pediatric stoma closure.
- Further research into perioperative interventions for high-risk pediatric patients is warranted to mitigate SSI.
Background:
Surgical site infection (SSI) is a burdensome complication following intestinal stoma closure, with reported rates ranging from 0% to 40%. We aimed to identify risk factors for SSI in children undergoing stoma closure.
Materials And Methods:
Using 2012-2014 NSQIP Pediatric data, we identified patients aged 0-18 years undergoing stoma closure. Demographic, clinical, and 30-day outcome characteristics between children with and without SSI were compared. A multivariable logistic model was used to identify predictors of SSI.
Results:
Among 2110 children who underwent stoma closure, 7.6% developed SSI. Patients who developed SSI had significantly longer time in the operating room, longer anesthesia times, longer total operation times, and longer lengths of stay (all P ≤ 0.01). Patients who developed SSI postoperatively had significantly higher rates of postoperative complications, including need for postoperative ventilation, sepsis, need for nutritional support on discharge, unplanned reoperation, unplanned readmission, postoperative lengths of stay >30 days, and transfusion within 72 hours after the start of surgery (all P ≤ 0.018). There was a significant relationship between operation time and SSI probability. Specifically, operation time greater than 105 minutes was associated with a higher SSI risk. On adjusted multivariable analyses, age, cardiac risk factors, Hirschsprung disease, and operation time greater than 105 minutes were independently predictive of SSI.
Conclusions:
Longer operation time, age, Hirschsprung disease, and cardiac risk factors are associated with an increased risk for SSI after stoma closure. Studies of perioperative adjuncts to reduce SSI in high-risk children based on expected procedure length and other preoperative characteristics are warranted.
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