Surgical Site Infections in Colon Surgery

Abstract

To determine the role of the surgeon in the occurrence of surgical site infection (SSI) following colon surgery, with respect to his or her adherence to guidelines and his or her experience. Design, Setting, and Patients: Prospective cohort study of 2393 patients who underwent colon surgery performed by 31 surgeons in 9 secondary and tertiary care public Swiss hospitals, recruited from a surveillance program for SSI between March 1, 1998, and December 31, 2008, and followed up for 1 month after their operation. Main Outcome Measures: Risk factors for SSI were identified in univariate and multivariate analyses that included the patients' and procedures' characteristics, the hospitals, and the surgeons as candidate covariates. Correlations were sought between surgeons' individual adjusted risks, their self-reported adherence to guidelines, and the delay since their board certification. Results: A total of 428 SSIs (17.9%) were identified, with hospital rates varying from 4.0% to 25.2% and individual surgeon rates varying from 3.7% to 36.1%. Features of the patients and procedures associated with SSI in univariate analyses were male sex, age, American Society of Anesthesiologists score, contamination class, operation duration, and emergency procedure. Correctly timed antibiotic prophylaxis and laparoscopic approach were protective. Multivariate analyses adjusting for these features and for the hospitals found 4 surgeons with higher risk of SSI (odds ratio [OR]=2.37, 95% confidence interval [CI], 1.51-3.70; OR = 2.19, 95% CI, 1.41-3.39; OR=2.15, 95% CI, 1.02-4.53; and OR=1.97, 95% CI, 1.18-3.30) and 2 surgeons with lower risk of SSI (OR=0.43, 95% CI, 0.19-0.94; and OR=0.19, 95% CI, 0.04-0.81). No correlation was found between surgeons' individual adjusted risks and their adherence to guidelines or their experience. Conclusion: For reasons beyond adherence to guidelines or experience, the surgeon may constitute an independent risk factor for SSI after colon surgery.

Hospital costs associated with surgical morbidity after elective colorectal procedures: a retrospective observational cohort study in 530 patients

“…The rates of superficial and deep wound infection noted in the present study are similar to data published by Hawn et al [19] and Tang et al [20], and compare favourably to values reported in several earlier publications [21-23]. Male sex, obesity, specific surgeons or hospitals, ostomy and total/subtotal colectomy were identified as risk factors for surgical site infection after colorectal surgery [22-25]. The circumscript number of cases present in our cohort did not allow subgroup analysis with regard to any technical aspects associated with SSI.…”

Characteristics of Antibiotic Prophylaxis and Risk of Surgical Site Infections in Open Colectomies

“…8,10,22,23 Important factors affecting this variation are differences in clinical case definition, 24 differences in definition based on billing information (in our study we varied between ICD-9 codes and billing for wound cultures), and follow-up time. 25,26 Indeed, 50% of SSI cases have been shown to occur after discharge 26 and, thus, were not captured in our data. Importantly, however, this underestimation is likely to be distributed equally among all types of antibiotic prophylaxis.…”

Gastrointestinal tract anastomoses with the biofragmentable anastomosis ring: is it still a valid technique for bowel anastomosis? Analysis of 203 cases and review of the literature

“…The overall incidence rate of surgical site infection following bowel surgery was observed to range between 5.8 and 17.9 % [20–22]. SSI rate following bowel surgery using BAR anastomosis was reported to be lower and ranging between 4.7 and 5.0 % in large series [7, 8, 13].…”