scholarly journals Beyond the operating room: do hospital characteristics have an impact on surgical site infections after colorectal surgery? A systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Rui Malheiro ◽  
Bárbara Peleteiro ◽  
Sofia Correia
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Safety Net ◽  
Public Hospitals ◽  
Main Body ◽  
Site Infection ◽  
Hospital Size ◽  
Surgeon Experience ◽  
Hospital Characteristics

Abstract Background Hospital characteristics have been recognized as potential risk factors for surgical site infection for over 20 years. However, most research has focused on patient and procedural risk factors. Understanding how structural and process variables influence infection is vital to identify targets for effective interventions and to optimize healthcare services. The aim of this study was to systematically review the association between hospital characteristics and surgical site infection in colorectal surgery. Main body A systematic literature search was conducted using PubMed, Scopus and Web of Science databases until the 31st of May, 2021. The search strategy followed the Participants, Exposure/Intervention, Comparison, Outcomes and Study design. The primary outcome of interest was surgical site infection rate after colorectal surgery. Studies were grouped into nine risk factor typologies: hospital size, ownership affiliation, being an oncological hospital, safety-net burden, hospital volume, surgeon caseload, discharge destination and time since implementation of surveillance. The STROBE statement was used for evaluating the methodological quality. A total of 4703 records were identified, of which 172 were reviewed and 16 were included. Studies were published between 2008 and 2021, and referred to data collected between 1996 and 2016. Surgical site infection incidence ranged from 3.2 to 27.6%. Two out of five studies evaluating hospital size adjusted the analysis to patient and procedure-related risk factors, and showed that larger hospitals were either positively associated or had no association with SSI. Public hospitals did not present significantly different infection rates than private or non-profit ones. Medical school affiliation and higher safety-net burden were associated with higher surgical site infection (crude estimates), while oncological hospitals were associated with higher incidence independently of other variables. Hospital caseload showed mixed results, while surgeon caseload and surveillance time since implementation appear to be associated with fewer infections. Conclusions Although there are few studies addressing hospital-level factors on surgical site infection, surgeon experience and the implementation of a surveillance system appear to be associated with better outcomes. For hospitals and services to be efficiently optimized, more studies addressing these variables are needed that take into account the confounding effect of patient case mix.

scholarly journals Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xufei Zhang ◽  
Zhiwei Wang ◽  
Jun Chen ◽  
Peige Wang ◽  
Suming Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Large Scale ◽  
Risk Index ◽  
Cross Sectional Study ◽  
Site Infection ◽  
Cross Sectional ◽  
Medical Expenses ◽  
Related Risk

Abstract Purposes Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors. Methods Two multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery. Results In total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088–3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926–7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200–0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187–0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group. Conclusion This study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China.

Risk Factors for Surgical Site Infection in Emergency Colorectal Surgery: A Retrospective Analysis

2014 ◽  
Vol 15 (3) ◽  
pp. 256-261 ◽  
Author(s):  
Masanori Watanabe ◽  
Hideyuki Suzuki ◽  
Satoshi Nomura ◽  
Kentaro Maejima ◽  
Naoto Chihara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Retrospective Analysis ◽  
Site Infection ◽  
Emergency Colorectal Surgery

scholarly journals Incidence and risk factors of surgical site infection following colorectal surgery in Iran: a prospective cohort study

2021 ◽  
Author(s):  
Siamak Rajaei ◽  
Masoud Mohammadi ◽  
Mohammad Hosein Taziki Balajelini ◽  
Reza Afghani ◽  
Mehrshad Zare ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Colon Surgery ◽  
Site Infection ◽  
Prospective Design ◽  
Related Risk ◽  
Scientific Principles ◽  
Golestan Province ◽  
Univariate Analyses

Abstract Background Surgical site infection (SSI) after colorectal surgery remains a significant problem for its negative clinical outcomes. The aim of this study was to determine the incidence of SSI after colorectal surgery in 5-Azar hospital of Gorgan, Golestan province, Iran and to further evaluate the related risk factors. Methods A prospective design was applied. Patients in the 5-Azar hospital of Gorgan, Golestan province, Iran was prospectively monitored for SSI after colorectal surgery. The demographic and perioperative characteristics were collected, and the main outcome were SSI within postoperative 30 days. Univariate analyses were used to identify risk factors. Results A total of 240 patients were enrolled in the study and the overall SSI rate was 23.3% (56 patients). Univariate analyses indicated that corticosteroids use (Risk Ratio (RR) = 3, 95% CI: 1.62–5.54), segmental resection with anastomosis (RR = 2.28, 95% CI: 1.12–4.63), anemia (RR = 4.52, 95% CI: 3.11–6.59), diabetics (RR = 2.68, 95% CI: 1.73–4.14), and opium use (RR = 1.87, 95% CI: 1.17–2.99) are risk factors for SSI. Conclusions SSI still seems to be a problem in colon surgery despite the observance of scientific principles. There are some risk factors for SSI that can be prevented.

Prevalence and risk factors for surgical site infection after colorectal surgery: a multiple-center prospective study of 3,663 consecutive patients in China

2020 ◽  
Author(s):  
Yu Zhang ◽  
Hui-Quan Gan ◽  
Jing-Fang Zhou ◽  
Ya-Jie Gong ◽  
Liu-Yi Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Prevalence Rate ◽  
Demographic Data ◽  
Risk Index ◽  
Klebsiella Pneumonia ◽  
Site Infection ◽  
Extended Spectrum Beta Lactamase

Abstract Background: Surgical site infection (SSI) after colorectal surgery (CRS) remains a significant problem for its negative clinical outcomes. However, it is poorly understood in China . This study aims to investigate the prevalence, risk factors and microbiology of SSI after CRS. Methods: A nationwide prospective multicenter design was applied. Patients in 19 Chinese hospitals from 2015 to 2018 were prospectively monitored for SSI after CRS. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using univariate and multivariate logistic regression models. Results: Among 3,663 study participants, 134(3.66%) episodes of SSI were identified. The prevalence rate of SSI decreased from 5.9 infections per 100 procedures in 2014 to 3.1 infections per 100 procedures in 2017 (prevalence rate ratio [PRR], 0.52; 95% CI, 0.28–0.94). The SSI rates were 1.88, 4.15, 6.27 and 11.58 per 100 operations for the National Nosocomial Infections Surveillance system (NNIS) risk index categories of 0, 1, and 2 or 3, respectively. Escherichia coli (54/134, 40.3%) and Klebsiella pneumoniae (10/134, 7.5%) were the most frequently isolated microorganisms. A high prevalence of antibiotic resistance were observed in our study, with rates of extended spectrum beta-lactamase-producing or carbapenem-resistant Escherichia coli and Klebsiella pneumonia of 50.0%(27/54) and 30.0%(3/10) respectively. Preoperative hospital stay ≥ 48h (OR=2.28, 95% CI: 1.03–5.02) and contaminated or dirty wound (OR=3.38, 95% CI: 1.88–6.06) were significantly associated with increasing risk of SSI after CRS. Conclusion: A statistically significant but modest decrease in the prevalence rate of CRS SSI over the 4-year study period was observed in this study. Noticeably, the relatively high rates of multidrug-resistant pathogens causing SSI after CRS should be alert despite of the small number of isolates identified in our survey.

Multivariate analysis of risk factors for surgical site infection after laparoscopic colorectal surgery

2013 ◽  
Vol 27 (12) ◽  
pp. 4574-4580 ◽  
Author(s):  
Joseph Drosdeck ◽  
Alan Harzman ◽  
Andrew Suzo ◽  
Mark Arnold ◽  
Mahmoud Abdel-Rasoul ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Laparoscopic Colorectal Surgery ◽  
Site Infection

scholarly journals Surgical Site Infection: The Clinical and Economic Impact

2019 ◽  
Vol 32 (03) ◽  
pp. 157-165 ◽  
Author(s):  
Megan Turner ◽  
John Migaly
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Length Of Stay ◽  
Surgical Site Infection ◽  
Economic Impact ◽  
Financial Incentives ◽  
Surgical Care ◽  
Site Infection ◽  
The Public

AbstractSurgical site infection (SSI) following colorectal surgery is associated with worse postoperative outcomes, longer length of stay, and higher rates of readmission. SSI rates have been established as a surrogate metric for the overall quality of surgical care and are intricately tied to financial incentives and the public reputation of an institution. While risk factors and prevention mechanisms for SSI are well established, the rates of SSI remain high. This article discusses the clinical and economic impact of SSI and strategies for mitigating the risk of SSI through bundled prevention practices.

scholarly journals Thirty-Day Readmission After Elective Colorectal Surgery for Colon Cancer: A Single-Center Cohort Study

2020 ◽  
Vol 36 (3) ◽  
pp. 186-191
Author(s):  
Jun Seong Chung ◽  
Han Deok Kwak ◽  
Jae Kyun Ju
Keyword(s):  
Risk Factors ◽  
Colon Cancer ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Disease Free Survival ◽  
Operation Time ◽  
Site Infection ◽  
Elective Colorectal Surgery ◽  
Factors Associated ◽  
Physical Status Classification

Purpose: There is a concern that enhanced recovery after surgery may affect other proposed quality measures, including the rate of readmission due to early discharge. We examine the 30-day readmission rate, risk factors associated with readmission after elective colorectal surgery for colon cancer, causes of readmission, disease-free survival (DFS), and overall survival (OS) in a single institution.Methods: We retrospectively investigated 292 patients who underwent elective colorectal surgery for colon cancer between 2010 and 2015. Baseline data including age, sex, body mass index, American Society of Anesthesiologists physical status classification, preoperative comorbidities, previous operation history, TNM stage, surgical approach, operation time, gas passage time, and length of hospital stay were obtained. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with 30-day readmission.Results: A total of 229 patients who underwent elective colorectal surgery were enrolled. Twenty-four patients were readmitted 30 days after discharge. The most common readmission diagnoses were wound bleeding or surgical site infection. Multivariate analysis indicated that patients who had preoperative hepatic disease were at the highest risk of readmission (odds ratio [OR], 8.98; 95% confidence interval [CI], 7.35–10.61). Survival outcomes were significantly better in the nonreadmitted group (OS, P=0.00; DFS, P=0.04).Conclusion: This study identified that preoperative comorbidities including hepatic and pulmonary diseases were associated with higher readmission rates after elective colorectal surgery. Moreover, the most common cause of readmission in patients who underwent elective colorectal surgery was wound bleeding or surgical site infection.

scholarly journals Risk factors for incisional surgical site infection after elective laparoscopic colorectal surgery

2019 ◽  
Vol 3 (2) ◽  
pp. 202-208 ◽  
Author(s):  
Keigo Chida ◽  
Jun Watanabe ◽  
Yusuke Suwa ◽  
Hirokazu Suwa ◽  
Masashi Momiyama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Surgical Site Infection ◽  
Laparoscopic Colorectal Surgery ◽  
Site Infection ◽  
Incisional Surgical Site Infection
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