Performance of surgical site infection risk prediction models in colorectal surgery: external validity assessment from three European national surveillance networks

2019 ◽  
Vol 40 (9) ◽  
pp. 983-990 ◽  
Author(s):  
Rebecca Grant ◽  
Martine Aupee ◽  
Nicolas C. Buchs ◽  
Kristine Cooper ◽  
Marie-Christine Eisenring ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Risk Model ◽  
Rectal Surgery ◽  
Predictive Ability ◽  
Specific Model ◽  
Colon And Rectal Surgery ◽  
National Surveillance ◽  
Site Infection ◽  
Surveillance Networks ◽  
Routinely Collected Data

AbstractObjective:To assess the validity of multivariable models for predicting risk of surgical site infection (SSI) after colorectal surgery based on routinely collected data in national surveillance networks.Design:Retrospective analysis performed on 3 validation cohorts.Patients:Colorectal surgery patients in Switzerland, France, and England, 2007–2017.Methods:We determined calibration and discrimination (ie, area under the curve, AUC) of the COLA (contamination class, obesity, laparoscopy, American Society of Anesthesiologists [ASA]) multivariable risk model and the National Healthcare Safety Network (NHSN) multivariable risk model in each cohort. A new score was constructed based on multivariable analysis of the Swiss cohort following colorectal surgery, then based on colon and rectal surgery separately.Results:We included 40,813 patients who had undergone elective or emergency colorectal surgery to validate the COLA score, 45,216 patients to validate the NHSN colon and rectal surgery risk models, and 46,320 patients in the construction of a new predictive model. The COLA score’s predictive ability was poor, with AUC values of 0.64 (95% confidence interval [CI], 0.63–0.65), 0.62 (95% CI, 0.58–0.67), 0.60 (95% CI, 0.58–0.61) in the Swiss, French, and English cohorts, respectively. The NHSN colon-specific model (AUC, 0.61; 95% CI, 0.61–0.62) and the rectal surgery–specific model (AUC, 0.57; 95% CI, 0.53–0.61) showed limited predictive ability. The new predictive score showed poor predictive accuracy for colorectal surgery overall (AUC, 0.65; 95% CI, 0.64–0.66), for colon surgery (AUC, 0.65; 95% CI, 0.65–0.66), and for rectal surgery (AUC, 0.63; 95% CI, 0.60–0.66).Conclusion:Models based on routinely collected data in SSI surveillance networks poorly predict individual risk of SSI following colorectal surgery. Further models that include other more predictive variables could be developed and validated.

What Is the Relationship between Operative Time and Adverse Events after Colon and Rectal Surgery?

2018 ◽  
Vol 84 (5) ◽  
pp. 712-716 ◽  
Author(s):  
Gabriela Poles ◽  
Caitlin Stafford ◽  
Todd Francone ◽  
Patricia L. Roberts ◽  
Rocco Ricciardi
Keyword(s):  
Colorectal Surgery ◽  
Adverse Events ◽  
Operative Time ◽  
Primary Anastomosis ◽  
Multivariable Analysis ◽  
Rectal Surgery ◽  
Surgical Site Infections ◽  
Colon And Rectal Surgery ◽  
Improvement Program ◽  
Tract Infections

We propose that prolonged colorectal surgery operative times are associated with increased 30-day adverse events. We identified a cohort from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from January 2005 through December 2012. Patients who underwent colectomy with primary anastomosis were selected using CPT codes. Operative time was categorized into short, average, and long based on mean operative times 61 SD. NSQIP-approved multivariate models were used to identify associations between operative time and 30-day adverse events. A total of 113,615 patients underwent colorectal resection of which 46 per cent were laparoscopic and 12 per cent were identified as long operative times. Patients with long operative procedures had 34 per cent more superficial surgical site infections, 65 per cent more organ space infections, 69 per cent more abdominal dehiscences, 44 per cent more thrombotic complications, 45 per cent more urinary tract infections, 40 per cent more returns to the operating room, and 36 per cent more prolonged lengths of stay ( P < 0.05 for all analyses). The multivariable analysis revealed an association between long operative times and increased adverse events despite adjustment for all NSQIP recommended covariates. Our results reveal increased 30-day adverse events with increased operative time. We propose that operative time may serve as a proxy for surgical complexity in colorectal surgery.

Is Laparoscopic Colon Surgery Appropriate in Patients who Have Had Previous Abdominal Surgery?

2009 ◽  
Vol 75 (10) ◽  
pp. 1015-1019 ◽  
Author(s):  
Andrew Barleben ◽  
Dhruvil Gandhi ◽  
Xuan-Mai Nguyen ◽  
Fred Che ◽  
Ninh T. Nguyen ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Abdominal Surgery ◽  
Conversion Rate ◽  
Laparoscopic Colorectal Surgery ◽  
Rectal Surgery ◽  
Length Of Hospital Stay ◽  
Colon Surgery ◽  
Colon And Rectal Surgery ◽  
History Of ◽  
Laparoscopic Techniques

Laparoscopic techniques in colon surgery reduce postoperative pain, length of hospital stay, and 30-day morbidity when compared with open surgery. The objective of this study was to determine the feasibility of a laparoscopic colectomy in patients who have previously undergone abdominal surgery. We performed a retrospective, single-institution review of laparoscopic colorectal procedures for benign or malignant pathology between October 2002 and September 2008. Our analysis included 55 patients who previously had laparoscopic, open, or a combination of procedures and subsequently underwent laparoscopic colorectal surgery. We observed a 14.5 per cent conversion rate (n = 8). Of the patients who had previous open procedures (n = 48 [87.3%]), the conversion rate was 16.7 per cent. Only one patient (12.5%) who had a history of only laparoscopic surgery required conversion. The highest conversion rate in our study was from patients who underwent a left colectomy (60%, n = 3/5), which was the only statistically significant factor found for conversion. Since the emergence of laparoscopy, use in colon and rectal surgery nationwide has been poor as a result of multiple factors, including a frequent history of abdominal surgery. Our experience shows that laparoscopic colorectal surgery in patients with prior intra-abdominal surgery can be completed with an acceptable conversion rate.

scholarly journals Predictive Risk Factors of Early Postoperative Enteric Fistula in Colon and Rectal Surgery

2013 ◽  
Vol 79 (10) ◽  
pp. 1058-1063 ◽  
Author(s):  
Hossein Masoomi ◽  
Joseph C. Carmichael ◽  
Steven Mills ◽  
Alessio Pigazzi ◽  
Michael J. Stamos
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Colorectal Surgery ◽  
Rectal Surgery ◽  
Multivariate Regression Analysis ◽  
High Rate ◽  
Teaching Hospitals ◽  
Colon And Rectal Surgery ◽  
Enteric Fistula ◽  
Abdominal Adhesions

Early postoperative enteric fistula (PEF) is a complication associated with a high rate of morbidity and mortality in colon and rectal surgery. We evaluated the effect of patient characteristics, comorbidities, pathology, resection type, surgical technique, lysis of adhesions, and admission type on the rate of PEF in colorectal surgery. Using the National Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2009 to 2010. A total of 646,414 patients underwent colorectal resection during this period. Overall, the rate of PEF was 0.37 per cent (2407 patients). Using multivariate regression analysis, Crohn's disease (adjusted odds ratio [AOR], 4.68), lysis of abdominal adhesions (AOR, 4.25), open procedure (AOR, 3.18), and transverse colectomy (AOR, 2.13) significantly impacted the risk of PEF. Although teaching hospitals (AOR, 1.69), obesity (AOR, 1.40), male gender (AOR, 1.30), emergent surgery (AOR, 1.27), age older than 65 years (AOR, 1.24), and diabetes mellitus (AOR, 1.21) also had statistically significant impact on rates of PEF, these were less clinically significant than the other factors. The presence of Crohn's disease and lysis of abdominal adhesions are strongly associated with the development of PEF after colorectal surgery. Laparoscopic surgery was associated with a lower rate of PEF; further studies would be needed to evaluate the importance of this finding.

Achieving Opioid-Free Major Colorectal Surgery: Is It Possible?

2020 ◽  
Vol 37 (5) ◽  
pp. 376-382
Author(s):  
Raymond Yap ◽  
George Nassif ◽  
Grace Hwang ◽  
Alvardo Mendez ◽  
Arman Erkan ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Management Strategies ◽  
Rectal Surgery ◽  
Postoperative Pain Management ◽  
Postanesthesia Care Unit ◽  
Colon And Rectal Surgery ◽  
Perioperative Morbidity ◽  
Specific Protocol ◽  
Narcotic Analgesia ◽  
Retrospective Nature

Introduction: Opioid analgesia remains the mainstay of postoperative pain management strategies despite being associated with many adverse effects. A specific opioid-free protocol was designed to limit opioid usage. Objective: The aim of the study was to audit the opioid-free rate within this protocol and to identify factors that might contribute to opioid-free surgery. Methods: A retrospective study of all elective patients receiving abdominal colorectal surgery at the Center for Colon and Rectal Surgery at AdventHealth over 6 months was performed. Data on demographics, indications, perioperative management, outcomes, and inpatient and outpatient analgesic requirements were collected with subsequent analysis. Results: A total of 303 consecutive patient records were analyzed. Approximately two-thirds (67.7%) of patients did not receive narcotics once they left the postanesthesia care unit as an inpatient. One-third of patients (32.0%) did not receive narcotic analgesia within 30 days of surgery as an outpatient. Patients in the opioid-free cohort were significantly older and had a malignant indication, less perioperative morbidity, and a shorter length of stay. Conclusions: Our study demonstrates that opioid-free analgesia is indeed possible in major colorectal surgery. Study limitations include its retrospective nature and that it is from a single institution. Despite these limitations, this study provides proof of concept that opioid-free colorectal surgery is possible within a specific protocol.

scholarly journals Body Mass Index Significantly Impacts Outcomes of Colorectal Surgery

2016 ◽  
Vol 82 (10) ◽  
pp. 930-935 ◽  
Author(s):  
Reza Fazl Alizadeh ◽  
Zhobin Moghadamyeghaneh ◽  
Matthew D. Whealon ◽  
Mark H. Hanna ◽  
Steven D. Mills ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Colorectal Surgery ◽  
Confidence Interval ◽  
Body Mass ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Rectal Surgery ◽  
Morbidly Obese ◽  
Colon And Rectal Surgery ◽  
Obese Patients

There are limited data regarding the association between body mass index (BMI) and colorectal surgery outcomes. We sought to evaluate the effect of BMI on short-term surgical outcomes in colon and rectal surgery patients in the United States. The American College of Surgeons National Surgery Quality Improvement Project database was used to identify all patients who underwent colon or rectal resection from 2005 to 2013. Multivariate regression analysis was used to assess the independent effect of BMI on outcomes. A total of 206,360 patients underwent colorectal resection during the study period. Of these, 3.2 per cent of patients were underweight (BMI < 18.5), 23.8 per cent patients were normal weight (18.5 ≤, BMI < 25), 26.5 per cent were overweight (25 ≤, BMI < 30), 25.2 per cent were obese (30 ≤, BMI < 40), and 5.3 per cent were morbidly obese (BMI ≥ 40). Underweight patients had longer length of stay (confidence interval: 2.70–3.49, P < 0.001) and higher mortality (adjusted odds ratio: 1.45, P < 0.01) compared with patients with a normal BMI. Morbidly obese patients had the highest overall morbidity rate compared with normal BMI patients (adjusted odds ratio: 1.53, confidence interval: 1.42–1.64, P < 0.01). BMI is associated with outcomes in colon and rectal surgery patients. Underweight and morbidly obese patients have a significantly increased risk of postsurgical complications compared with those with normal BMI.

Colon and rectal surgery surgical site infection reduction bundle: To improve is to change

2019 ◽  
Vol 217 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Sook C. Hoang ◽  
Adam A. Klipfel ◽  
Leslie A. Roth ◽  
Mathew Vrees ◽  
Steven Schechter ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Rectal Surgery ◽  
Colon And Rectal Surgery ◽  
Site Infection ◽  
Infection Reduction

Factors Associated with Surgical Site Infection in Colorectal Surgery: The Japan Nosocomial Infections Surveillance

2014 ◽  
Vol 35 (6) ◽  
pp. 660-666 ◽  
Author(s):  
Keita Morikane ◽  
Hitoshi Honda ◽  
Takuya Yamagishi ◽  
Satowa Suzuki ◽  
Mayumi Aminaka
Keyword(s):  
Nosocomial Infections ◽  
Risk Index ◽  
Rectal Surgery ◽  
Emergency Operation ◽  
Healthcare Associated Infections ◽  
Colon And Rectal Surgery ◽  
Site Infection ◽  
Factors Associated ◽  
Male Sex ◽  
Healthcare Associated

Objective.Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). This study aims to assess factors associated with SSI after colorectal surgery in Japan, using a Japanese national database for HAIs.Design.A retrospective nationwide surveillance-based study.Setting.Japanese healthcare facilities.Methods.Data on colon and rectal surgeries performed from 2008 through 2010 were extracted from a national monitoring system for healthcare-associated infections, the Japan Nosocomial Infections Surveillance (JANIS). Factors associated with SSI after colon and rectal surgery were assessed using multivariate logistic regression.Results.The cumulative incidence of SSI for colon and rectal surgery was 15.0% (6,691 of 44,751) and 17.8% (3,230 of 18,187), respectively. Traditional risk factors included in the National Nosocomial Infections Surveillance (NNIS) modified risk index were significant in predicting SSI in the final model for both colon and rectal surgery. Among the additional variables routinely collected in JANIS were factors independently associated with the development of SSI, such as male sex (adjusted odds ratio [aOR], 1.20 [95% confidence interval (CI), 1.14–1.27]), ileostomy or colostomy placement (aOR, 1.13 [95% CI, 1.04–1.21]), emergency operation (aOR, 1.40 [95% CI, 1.29–1.52]), and multiple procedures (aOR, 1.22 [95% CI, 1.13–1.33]) for colon surgery as well as male sex (aOR, 1.43 [95% CI, 1.31–1.55]), ileostomy or colostomy placement (aOR, 1,63 [95% CI, 1.51–1.79]), and emergency operation (aOR, 1.43 [95% CI, 1.20–1.72]) for rectal surgery.Conclusions.For colorectal operations, inclusion of additional variables routinely collected in JANIS can more accurately predict SSI risk than can the NNIS risk index alone.Infect Control Hosp Epidemiol 2014;35(6):660–666

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