Surgical site infections after lung resection: a prospective study of risk factors in 1,091 consecutive patients

Abstract

Background: To assess incidence and risk factors of surgical site infections (SSI) (wound infection, pneumonia, empyema) in a monocentric series of patients undergoing lung resection over a decade. Methods: All patients undergoing lung resection at our institution in 2006-2015 [wedge resection, n=579; lobectomy, n=472 (12% after chemo/radiotherapy); pneumonectomy, n=40 (47% after chemo/radiotherapy)], were prospectively enrolled. Perioperative SSI risk factors were recorded: age, gender, blood haemoglobin, Results: Of the 1,091 resected patients [median age, 65 (range, 13-91) years; male, 74%; malignancy, 65%], 124 (11.4%) developed one or more SSI. Wound infection, pneumonia and empyema rates were respectively 3.2%, 8.3% and 1.9%, stable through the decade. Overall infection rates after wedge resection, lobectomy and pneumonectomy were 4.8%, 17.4% and 35.0%, respectively. Thirty-day postoperative mortality was 0.6%; of the 7 deaths, 4 were causally related with SSI. Multivariable analysis showed that male gender, diabetes, preoperative steroids, induction chemo/radiotherapy, missed antibiotic prophylaxis and resection type were independent risk factors for overall SSI.Conclusions: SSI rates after lung resection were stable over the decade. The observed 11.4% frequency of SSI indicates that postoperative infections remain a relevant issue and a predominant cause of mortality after lung surgery. Focusing on SSI risk factors that are perioperatively modifiable may improve surgical results.

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

“…Previous studies have identified different, independent risk factors for SSI, also including patients' characteristics, procedures during hospitalization and characteristics depends of thoracic surgery procedure [1][2][3][4][5]. In the present study multivariate logistic regression analysis identified five independent risk factors associated with SSI: wound microbiology contamination, ASA score, duration of pleural drainage, age, and duration of operation.…”

“…The lobectomy was the most common operative procedure performed in our patients, accounting for 944 (28.0%) of the studied operative procedures with SSI IR of 7.7%. During open lobectomy, Imperatori et al reported IR of SSI of 17.0%, IR of wound infection of 3.9% and IR of empyema of 3.2% in period 2006-2015 [1]. These differences could be explained by the fact that the authors from Italy were calculating IR of lobectomy and bilobectomy together/combined, and in our study, we were calculating IR of lobectomy and bilobectomy separately.…”

“…SSI in patients with thoracic surgical procedures causes significant morbidity and mortality and prolongs hospital stays [1][2][3][4][5]. In this study we analyzed SSI in a large cohort of patients with thoracic surgical procedures.…”

“…Despite the recent advances in operating surgical techniques, better understanding of the pathogenesis of infections and widespread use of modern antiseptic agents and prophylactic antibiotics, surgical site infections (SSI) continue to be a major problem for patients undergoing thoracic surgery [1][2][3] SSI are associated with increased morbidity, in-hospital mortality, prolonged hospitalization, and increased costs [4]. Surveillance of SSI provides useful data in identifying risk factors that contribute to the development and outcome of SSI [5].…”

Rationale perioperative Antibiotikatherapie in der Thoraxchirurgie

“…Adequate Perioperative Use of Antibiotics in Thoracic Surgery Einleitung Neben dem postoperativen Wundinfekt und dem Pleuraempyem gilt die postoperative Pneumonie als eine schwere Komplikation nach lungenresezierenden Eingriffen [1]. In einer aktuellen prospektiven Studie entwickelten 22,5 % der Patienten nach Pneumektomie eine postoperative Pneumonie mit einer Mortalität von 5 % [2]. Als Risikofaktoren hierfür sind u. a. chronische Lungenerkrankungen, Übergewicht, hohes postoperatives Schmerzniveau und eine bakterielle Kolonisation des Tracheobronchialsystems beschrieben [3 -5].…”