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Surgical site infection after colorectal surgery in a tertiary-level cancer center: Risk factors, clinical
Marco Antonio Delaye-Martinez1, Gustavo Mendez-Hirata2, Javier Melchor-Ruan3
1Plan de Estudios Combinados en Medicina (PECEM), PhD Programme, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico.
Background:
Surgical site infections (SSIs) are a common complication in colorectal surgery. In colorectal cancer (CRC), SSIs increase recurrence and mortality. This study aimed to describe the frequency, risk factors, and mortality of patients with SSIs at a cancer center.
Methods:
An observational, retrospective study was conducted from 2018 to 2022, including patients with CRC who underwent elective colorectal surgery. Risk factors for SSI were assessed using multivariable logistic regression analysis. A 5-year survival analysis was performed using the Kaplan-Meier curves, and hazard ratios were calculated using the Cox proportional hazards method.
Results:
We included 712 patients; SSI occurred in 28%. Risk factors included preoperative hemoglobin ≤ 8.5g/dL (OR 3.21, P = .04) and intraoperative mean arterial blood pressure < 65 mm Hg (OR 5.12, P < .001). Adequate perioperative antimicrobial prophylaxis reduced the SSI risk (OR 0.53, P = .04). Increased mortality was associated with surgical diversion (HR 2.54, P < .001), hospital-acquired pneumonia (HR 4.02, P < .001), and septic shock (HR 14.21, P < .001). Overall 5-year survival was lower in SSI patients (70% vs 82%; log-rank, P = .021).
Conclusions:
SSIs in CRC were higher compared with other series. Preoperative anemia and intraoperative low perfusion were strong predictors of SSI development. An adequate perioperative antimicrobial prophylaxis significantly reduced SSIs. Patients with SSIs experienced higher mortality rates.
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