Impact of Obesity on Surgical Site Infection in Colon and Rectal Surgery

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.

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IMPACT OF ORAL ANTIBIOTIC PROPHYLAXIS ON SURGICAL SITE INFECTION AFTER RECTAL SURGERY: RANDOMIZED CONTROLLED TRIAL

Koloproktologia ◽

10.33878/2073-7556-2019-18-1-74-81 ◽

2019 ◽

Vol 18 (1) ◽

pp. 74-81

Author(s):

Yu. A. Shelygin ◽

M. A. Nagudov ◽

A. A. Ponomarenko ◽

E. G. Rybakov ◽

M. A. Suhina

Keyword(s):

Surgical Site Infection ◽

Anastomotic Leakage ◽

Controlled Trial ◽

Rectal Surgery ◽

Generation Cephalosporin ◽

Control Group ◽

Oral Antibiotic ◽

Site Infection ◽

Oral Antibiotics ◽

Bowel Cleansing

AIM: to evaluate the efficacy of preoperative oral antibiotics in reduction of surgical site infection (SSI) in rectal surgery. METHODS: patients undergoing rectal resection were assigned randomly to 2 groups: control (standard preoperative care and intravenous injection of 3d generation cephalosporin) and oral antibiotics group (the above was complemented by three-knit oral metronidazole 500 mg and erythromycin 500 mg after beginning of mechanical bowel cleansing at 5.00, 8.00 and 10.00 p.m.). The primary endpoint was the overall rate of SSI. RESULTS: between November 2017 and October 2018, 104 patients (48 in the oral antibiotics group and 56 in control group) were enrolled for this study. The incidence of SSIs was 19.6% (11/56) in control group and 4.1% (2/48) in the oral antibiotics group(р=0.01). Both groups had no statistically significant differences in intensity of SSIs and rate of anastomotic leakage. CONCLUSION: preoperative oral antibiotic significantly reduced the risk of SSIs following rectal surgery. The study needs to be continued for evaluation of preoperative oral antibiotics impact to intensity of SSIs and rate of anastomotic leakage.

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Incidence of Surgical Site Infection and Risk Factors in Rectal Surgery: A Prospective Cohort Study

Cirugía Española (English Edition) ◽

10.1016/j.cireng.2018.11.012 ◽

2018 ◽

Vol 96 (10) ◽

pp. 640-647

Author(s):

Enrique Colás-Ruiz ◽

Juan Antonio Del-Moral-Luque ◽

Pablo Gil-Yonte ◽

José María Fernández-Cebrián ◽

Marcos Alonso-García ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Surgical Site Infection ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Rectal Surgery ◽

Site Infection

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Impact of oral antibiotic prophylaxis on surgical site infection after rectal surgery: results of randomized trial

International Journal of Colorectal Disease ◽

10.1007/s00384-020-03746-0 ◽

2020 ◽

Author(s):

Evgeny Rybakov ◽

Marat Nagudov ◽

Marina Sukhina ◽

Yuri Shelygin

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Randomized Trial ◽

Rectal Surgery ◽

Oral Antibiotic ◽

Site Infection ◽

Oral Antibiotic Prophylaxis

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

Infection Control and Hospital Epidemiology ◽

10.1086/676438 ◽

2014 ◽

Vol 35 (6) ◽

pp. 660-666 ◽

Cited By ~ 30

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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FACTORS RELATED TO THE REDUCTION OF THE RISK OF COMPLICATIONS IN COLORECTAL SURGERY WITHIN PERIOPERATIVE CARE RECOMMENDED BY THE ACERTO PROTOCOL

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020190001e1477 ◽

2019 ◽

Vol 32 (4) ◽

Cited By ~ 1

Author(s):

Alberto BICUDO-SALOMÃO ◽

Rosana de Freitas SALOMÃO ◽

Mariani Parra CUERVA ◽

Michelle Santos MARTINS ◽

Diana Borges DOCK-NASCIMENTO ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Perioperative Care ◽

Protective Factor ◽

Rectal Surgery ◽

Site Infection ◽

Preoperative Fasting ◽

Increased Risk ◽

Anastomotic Fistula ◽

Independent Risk Factors

ABSTRACT Background: Perioperative care multimodal protocol significantly improve outcome in surgery. Aim: To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol. Methods: Cohort study analyzing through a logistic regression model able to assess independent risk factors for morbidity and mortality, patients submitted to elective open colon and/or rectum resection and primary anastomosis who were either exposed or non-exposed to demographic, clinical, and ACERTO interventions. Results: Two hundred thirty four patients were analyzed and submitted to 156 (66.7%) rectal and 78 (33.3%) colonic procedures. The length of hospital postoperative stay (LOS) ≥ 7 days was related to rectal surgery and high NNIS risk index; preoperative fasting ≤4 h (OR=0.250; CI95=0.114-0.551) and intravenous volume of crystalloid infused > 30ml/kg/day (OR=0.290; CI95=0.119-0.706). The risk of postoperative site infection (SSI) was approximately four times greater in malnourished; eight in rectal surgery and four in high NNIS index. The duration of preoperative fasting ≤4 h was a protective factor by reducing by 81.3% the risk of surgical site infection (SSI). An increased risk for anastomotic fistula was found in malnutrition, rectal surgery and high NNIS index. Conversely, preoperative fasting ≤4 h (OR=0.11; CI95=0.05-0.25; p<0.0001) decreased the risk of fistula. Factors associated with pneumonia-atelectasis were cancer and rectal surgery, while preoperative fasting ≤ 4 h (OR=0.10; CI95=0.04-0.24; p<0.0001) and intravenous crystalloid ≤ 30 ml/kg/day (OR=0.36; CI95=0.13-0.97, p=0.044) shown to decrease the risk. Mortality was lower with preoperative fasting ≤4 h and intravenous crystalloids infused ≤30 ml/kg/day. Conclusion: This study allows to conclude that rectal procedures, high NNIS index, preoperative fasting higher than 4 h and intravenous fluids greater than 30 ml/kg/day during the first 48 h after surgery are independent risk factors for: 1) prolonged LOS; 2) surgical site infection and anastomotic fistula associated with malnutrition; 3) postoperative pneumonia-atelectasis; and 4) postoperative mortality.

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