Surgical Site Infection and Colorectal Surgical Procedures: A Prospective Analysis of Risk Factors

Area of Science:

• Surgical outcomes research
• Infectious disease epidemiology
• Colorectal surgery

Background:

• Colorectal surgical procedures (CRS) exhibit the highest surgical site infection (SSI) rates among elective surgeries.
• Existing research often relies on retrospective data or limited analyses of CRS.
• This study focuses on prospectively collected data within an elective CRS cohort.

Purpose of the Study:

• To identify significant risk factors for SSI in elective colorectal surgery.
• To analyze prospectively collected data to determine SSI predictors.
• To calculate predicted SSI risks based on identified factors.

Main Methods:

• Analysis of prospectively collected data from a randomized, blinded trial in elective CRS.
• Identification of SSI (superficial, deep, or cellulitis) within 30 days post-discharge.
• Utilized photodocumentation, patient questionnaires, and surgeon review for SSI confirmation.
• Employed multivariable logistic regression to identify significant risk factors and predict SSI risk.

Main Results:

• The study analyzed 787 patients undergoing clean-contaminated CRS from 2011-2015.
• The overall SSI rate was 21.5%.
• Four variables significantly associated with SSI were identified: incision length, surgical indication, body mass index, and surgical approach.
• Predicted SSI risk varied widely, from less than 5% to over 60% based on these factors.

Conclusions:

• This is the largest prospective study investigating SSI in elective CRS.
• A broad spectrum of SSI risk exists following CRS, influenced by modifiable and non-modifiable factors.
• Identifying patients at high or low risk can aid in targeted infection prevention strategies.