Surgical site infection in patients submitted to digestive surgery: Risk prediction and the NNIS risk index

Oliveira, Adriana Cristina de; Ciosak, Suely Itsuko; Ferraz, Edmundo Machado; Grinbaum, Renato Satovschi

doi:10.1016/j.ajic.2005.12.011

Cited by 94 publications

(65 citation statements)

References 24 publications

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“…The correlation between BMI and SSI was reported in the literature repeatedly (14,27,28). The composition of adipose tissue is relatively avascular, and a wound with a higher amount of adipose tissue will have a lower tissue oxygenation.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting surgical site infection rate after elective gastric cancer surgery

Özmen

Javadov

Yeğen

2016

UCD

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Objective: Surgical site infection (SSI) is a common complication after surgery and is an indicator of quality of care. Risk factors for SSI are studied thoroughly for most types of gastrointestinal surgeries and especially colorectal surgeries, but accumulated data is still lacking for gastric surgeries. We studied the parameters affecting SSI rate after gastric cancer surgery. Material and Methods:Consecutive patients, who underwent elective gastric cancer surgery between June and December 2013, were included. Descriptive parameters, laboratory values and past medical histories were recorded prospectively. All patients were followed for 1 month. Recorded parameters were compared between the SSI (+) and SSI (-) groups.Results: Fifty-two patients (mean age: 58.87±9.25 ; 67% male) were included. SSI incidence was 19%. ASA score ≥3 (p<0.001), postoperative weight gain (p<0.001), smoking (p=0.014) and body mass index (BMI) ≥30 (p=0.025) were related with a higher SSI incidence. Also patients in the SSI (+) group had a higher preoperative serum C-reactive protein level (p=0.014). Conclusion:We assume that decreasing BMI to <30, stopping smoking at least 3 weeks before the operation, and preventing postoperative weight gain by avoiding excessive intravenous hydration will all help decrease SSI rate after gastric surgery. Keywords: Gastric cancer, surgical site infection, risk factors INTRODUCTIONThe incidence of gastric cancer has been decreasing throughout the last decades after effective eradication of Helicobacter pylori infection, improved sanitation, refrigeration and a shift towards the consumption of fresh fruit and vegetables rather than red meat and high fat diet (1, 2). Nevertheless, gastric cancer still remains to be the third most common cause of cancer related deaths (3), and gastric cancer surgery is a commonly performed surgery in especially busy tertiary care centers.Surgical site infections (SSI) are responsible for 38% of nosocomial infections (4, 5), and is one of the most prominent morbidity after gastric surgery. Surgical site infections causes prolonged hospitalization and increased surgery related costs (6, 7). ASA score, wound classification and duration of the operation are the 3 SSI-related factors established by the National Nosocomial Infection Surveillance (NNIS) (8-10). Risk factors for SSI are studied thoroughly for most types of gastrointestinal surgeries and especially colorectal surgeries, but accumulated data is still lacking for gastric surgeries (11, 12).Our hospital is a tertiary care center with more than 200 gastric cancer surgeries a year. In our clinic, we experience a higher SSI rate than the stated rate (3-16%) for gastric surgeries in the literature (13)(14)(15). In this study, our goal is to determine the factors affecting SSI rate after gastric surgery. MATERIAL AND METHODS Patients and Study DesignThe subjects of our prospective observational cohort study were consecutive patients who underwent elective gastric surgery (distal subtotal or total gastrectomy with D2 lymph...

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Section: Discussionmentioning

confidence: 99%

Factors affecting surgical site infection rate after elective gastric cancer surgery

Özmen

Javadov

Yeğen

2016

UCD

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“…O mesmo não ocorreu nas extra-hospitalares, provavelmente devido ao número reduzido dessas infecções na população acompanhada. É possível também que essas diferenças se devam ao próprio IRIC, cuja validade como preditor de risco de infecção de sítio cirúrgico tem sido questionada 24 .…”

Section: Discussionunclassified

Vigilância pós-alta das infecções de sítio cirúrgico em crianças e adolescentes em um hospital universitário de Belo Horizonte, Minas Gerais, Brasil

et al. 2008

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IntroduçãoAs infecções hospitalares podem ser atribuídas ao hospital e se manifestar durante a internação ou após a alta hospitalar. É notória a sua importância, pois aumentam a morbidade, mortalidade e os custos hospitalares, sendo as principais complicações nos pacientes cirúrgicos nos quais as infecções de sítio operatório são as mais freqüentes 1 .As infecções de sítio cirúrgico, anteriormente denominadas infecções de ferida operatória, acometem tecidos e órgãos incisados e cavidades manipuladas durante um procedimento cirúr-gico 2 . Sabe-se que um extensivo programa de vigilância pode reduzir as taxas de infecções de sítio cirúrgico em 30% a 40%, mas para que este programa seja efetivo deve-se conhecer a real incidência destas infecções e os fatores de risco associados 3 . As freqüências das infecções de sí-tio cirúrgico têm sido utilizadas como um importante indicador da performance dos cirurgiões e do hospital, sendo que o retorno dos dados da vigilância à equipe cirúrgica pode reduzir as taxas de infecção em até 35% 3,4 .Na vigilância das infecções de sítio cirúrgi-co, utiliza-se o componente cirúrgico do sistema de vigilância das infecções hospitalares National Nosocomial Infections Surveillance (NNIS) do Centers for Disease Control and Prevention (CDC, Estados Unidos) 5 , no qual os pacientes devem ser acompanhados até o 30 o dia do pós-ARTIGO ARTICLE

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“…15 The comparison of SSI incidence between hospitals from different locations and countries must always be carefull, as there are specific characteristics for each place and patient population that make it difficult to reach valid conclusions. The ideal situation would be for each hospital to critically analyze its own data, preferably focusing such analysis on the historical series and particularizing it for the several types of surgery.…”

Section: 12-19mentioning

confidence: 99%

Surgical-site infection risk in oncologic digestive surgery

Castro¹,

Carvalho²,

Peres³

et al. 2011

Braz J Infect Dis

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Surgical-site infection (SSI) is the most prevalent type of hospital infection in surgical patients and is associated with an increase in hospital stay, costs and morbidity/lethality. The knowledge of the main risk factors for this type of infection is important for the establishment of prevention measures regarding modifiable risks factors. The objective of the preset study was to assess the occurrence of SSI and study the risk factors in oncologic surgeries of the digestive system at Hospital de Câncer in Barretos, São Paulo, Brazil. Individuals undergoing oncologic surgeries of the digestive system in the period of 08/01/2007 to 08/10/2008 were prospectively followed for 30 days after surgery. Possible risk factors related to the patient and to the surgical procedure were also studied. A total of 210 surgeries were analyzed, with a global SSI incidence of 23.8%. The following variables were independently associated with SSI: time and type of surgery, radiotherapy before surgery and surgeon's years of experience. The risk factors found in this study have been described by other authors and are not amenable to intervention for SSI prevention. Further studies are recommended with the objective of investigating interventions that could reduce the risk for SSI in this type of surgery.

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Surgical site infection in patients submitted to digestive surgery: Risk prediction and the NNIS risk index

Cited by 94 publications

References 24 publications

Factors affecting surgical site infection rate after elective gastric cancer surgery

Factors affecting surgical site infection rate after elective gastric cancer surgery

Vigilância pós-alta das infecções de sítio cirúrgico em crianças e adolescentes em um hospital universitário de Belo Horizonte, Minas Gerais, Brasil

Surgical-site infection risk in oncologic digestive surgery

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