Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties

Abstract

BACKGROUND:Surgical site infections (SSIs) are well-recognized complications after exploratory laparotomy for abdominal trauma; however, little is known about SSI development after exploration for battlefield abdominal trauma. We examined SSI risk factors after exploratory laparotomy among combat casualties. METHODS:Military personnel with combat injuries sustained in Iraq and Afghanistan (June 2009 to May 2014) who underwent laparotomy and were evacuated to participating US military hospitals were included. Log-binominal regression was used to identify SSI risk factors. RESULTS:Of 4,304 combat casualties, 341 patients underwent a total of 1,053 laparotomies. Abdominal SSIs were diagnosed in 49 patients (14.4%): 8% with organ space SSI, 4% with deep incisional SSI, and 4% with superficial SSIs (4 patients had multiple SSIs).Patients with SSIs had more colorectal (p < 0.001), small bowel (p = 0.010), duodenum (p = 0.006), pancreas (p = 0.032), and abdominal vascular injuries (p = 0.040), as well as prolonged open abdomen (p = 0.004) and more infections diagnosed before the SSI (or final exploratory laparotomy) versus non-SSI patients (p < 0.001). Sustaining colorectal injuries (risk ratio [RR], 3.20; 95% confidence interval [CI], 1.58-6.45), duodenum injuries (RR, 6.71; 95% CI, 1.73-25.58), and being diagnosed with prior infections (RR, 10.34; 95% CI, 5.05-21.10) were independently associated with any SSI development. For either organ space or deep incisional SSIs, non-intra-abdominal infections, fecal diversion, and duodenum injuries were independently associated, while being injured via an improvised explosive device was associated with reduced likelihood compared with penetrating nonblast (e.g., gunshot wounds) injuries. Non-intra-abdominal infections and hypotension were independently associated with organ space SSIs development alone, while sustaining blast injuries were associated with reduced likelihood. CONCLUSION:Despite severity of injuries and the battlefield environment, the combat casualty laparotomy SSI rate is relatively low at 14%, with similar risk factors and rates reported following severe civilian trauma.

[Retracted] Study on Risk Factors and Nutritional Status of Postoperative Infection in Patients Undergoing Abdominal Surgery

“…After abdominal surgery, the body resistance is reduced, which is prone to infection and other complications [ 13 ]. With basic diseases such as diabetes mellitus patients, as a result of their disease influence white blood cell function is impaired, the immunity worsens, further reducing anti-infection ability, and patients with hypertension are affected by abnormal blood pressure index, which affects local blood circulation at the surgical site after operation and delays wound healing [ 14 , 15 ]. Some studies showed that the long operation time inevitably brings about long incision length.…”

Anastomotic Outcomes in Military Exploratory Laparotomies in the Modern Combat Era

“…As noted by Bozzay et al, 14.4% of 341 combat casualties who underwent combat-related exploratory laparotomies developed an abdominal SSI with the majority being organ space or deep incisional (12.0%). 13,16 In this more restricted TIDOS population, the overall proportion of any SSIs was 25.3%, while it was 19.5% for either deep incisional or organ space SSIs and it is possible that distinguishing a true meaningful difference regarding the development of abdominal SSIs between the groups was hindered by the low numbers included in the study.…”

“…Retrospective review of clinical findings, medical records, imaging, and laboratory results were utilized to classify abdominal SSIs as superficial, deep incisional, or organ space, as previously described. 13 Chi-squared or Fisher's exact tests were used to detect differences between patients with and without anastomotic failure for categorical variables, and the Kruskal-Wallis test was used for continuous variables. A P value <.05 was deemed statistically significant.…”

“…Retrospective review of clinical findings, medical records, imaging, and laboratory results were utilized to classify abdominal SSIs as superficial, deep incisional, or organ space, as previously described. 13…”

Revisión bibliográfica: manejo del Trauma Penetrante de Abdomen

“…En consecuencia, los pacientes a menudo quedan con el abdomen abierto, con medidas de hemostasia temporales o con discontinuidad intestinal hasta que son evacuados a niveles superiores de atención para el tratamiento quirúrgico definitivo o se encuentran más estables. (Bozzay et al, 2021) En la figura 3 se observa una laparotomía exploratoria en un Traumatismo penetrante en la arteria ilíaca derecha.…”