Classification and Risk Factors for Surgical Site Infections in Radical Cystectomy: A 16-Year Analysis

Area of Science:

• Urology
• Surgical Oncology
• Infectious Disease

Background:

• Surgical site infection (SSI) is a significant complication following radical cystectomy (RC), impacting patient morbidity.
• Identifying risk factors and understanding treatment patterns for SSIs after RC is crucial for improving patient outcomes.

Purpose of the Study:

• To identify independent risk factors for developing SSI after radical cystectomy (RC).
• To classify and characterize the treatment strategies for different types of SSIs post-RC.

Main Methods:

• Retrospective analysis of peri-operative characteristics and SSI data for patients undergoing RC between 2007 and 2022.
• Patients were stratified into SSI and no-SSI groups; logistic regression analyses were used to identify associated factors.
• SSIs were categorized according to Centers for Disease Control and Prevention (CDC) classifications: superficial incisional, deep incisional, and organ/space.

Main Results:

• Of 398 RC patients (279 open, 119 robotic), 78 (19.6%) developed SSI. Patients with SSI had a higher BMI (25.39 vs. 24.34) and longer length of stay (12.4 vs. 8.8 days).
• Body mass index (BMI) was identified as an independent risk factor for SSI (OR: 1.06, p=0.02). Surgical approach (open vs. robotic) was not a significant predictor.
• Superficial incisional SSIs (12.8%) were managed conservatively with antibiotics. Deep incisional SSIs (30.8%) required antibiotics and 50% needed surgical intervention. Organ/space SSIs (56.4%) were treated with antibiotics and often required IR drain placement (68.2%).

Conclusions:

• Elevated BMI is a significant independent risk factor for surgical site infections following radical cystectomy.
• The type of surgical approach (robotic vs. open) does not influence SSI risk. Management strategies for SSIs vary based on their classification (superficial, deep, or organ/space).