Surgical site infection incidence and risk factors in thoracic surgical procedures: A 12-year prospective cohort study

Abstract

Introduction: Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures.
 Methodology: During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI.
 Results: We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified: wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI): 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR: 1.795; 95% CI: 1.136-2.834), duration of drainage (p < 0.001; RR: 1.117; 95% CI: 1.085-1.150), age (p = 0.036; RR: 1.018; 95% CI: 1.001-1.035) and duration of operation (p < 0.001; RR:1.005; 95% CI:1.002-1.008).
 Conclusion: The results are valuable in documenting risk factors for SSI in patients undergoing thoracic surgery. The knowledge and prevention of controllable risk factors is necessary in order to reduce the incidence of SSI.

Surgical Site Infections Are Associated With Higher Blood Loss and Open Access in General Thoracic Practice

“…The overall SSI rate was 1.5%, which reflects current literature rates mentioned above (6)(7)(8)(9)(10)(11). There is no consensus on criteria for the diagnosis of SSI (1,4,18).…”

“…Only 36 of the 512 anatomical resections were performed with VATS. Cvijanović et al reported a SSI rate of 6.1% in thoracic surgery in 3,370 patients over a 12-year period (VATS: 2.14%, Open 7.1%), but the result was not significant in a multivariate analysis aiming to identify SSI risk factor and only 30 of the 1,319 anatomical resections were performed by VATS (10). In all these studies, the compared groups were rather heterogeneous, and although the study of Cvijanović et al is one of the largest studies investigating this matter in thoracic surgery so far, the long study period includes a lot of changes in patient treatment (used disinfectant, preoperative antibiotics, surgical technique, etc.).…”

“…Higher SSI rates can be found after colectomies (18.4%) (5). In thoracic surgery, there are some studies reporting SSI occurrence ranging from 0.3 to 6.1%, but no study looks specifically for factors associated with this burden in a recent period and in a fully implemented minimal invasive practice (6)(7)(8)(9)(10)(11).…”

“…Recent studies report fewer postoperative complications, shorter hospital stay, and shorter chest tube duration without compromising oncological outcomes in VATS (8,19,23). Only two studies specifically analyze the risk factors for SSI in thoracic surgery in relation to open or minimally invasive surgery (10,24). However, they are not able to demonstrate open surgery as a risk factor for SSI in comparison with minimal invasive surgery and they cover a long period of time before the implementation of VATS surgery for anatomical lung resections.…”

Five-Year Experience with VATS Versus Thoracotomy Segmentectomy for Lung Tumor Resection

“…23 There is support in the literature of lower incidence of surgical site infections with minimally invasive approach compared to thoracotomy. Recently, Cvijanović et al published a 12-year retrospective study comparing risk factors and incidence of surgical site infections (SSI) in thoracic surgical procedures including wedge resection, lobectomy, and pnuemontoecmy 24 with reported cumulative SSI rates of 2.2% in the VAT surgical group compared to 3.5% after open thoracotomy. However, no segmentectomy group was reported in the study.…”