Abstract
BackgroundColorectal surgery is associated with high rates of surgical site infection (SSI). We investigated SSI in radical resection of colon or rectal carcinoma and its epidemiological distribution in 26 hospitals in China.MethodsWe conducted prospective surveillance of patients who underwent radical resection of colon or rectal carcinoma in 26 selected hospitals from January 2015 to June 2016.An information system monitored all of the surgical inpatients. Infection control professionals observed the inpatients with suspected SSI who had been screened by the system at the bedside. The infection status of the incisions was followed up by telephone 1 month after the operation.ResultsIn total, 5729 patients were enrolled for the two operations; SSIs occurred in 206 patients, and the infection rate was 3.60%. The incidence of SSI after radical resection of rectal carcinoma (5.12%; 119/2323) was 2.1 times higher than that after radical resection of colon carcinoma (2.55%; 87/3406) (P < 0.0001). Additionally, in the colon versus rectal groups, the rate of superficial incisional SSI was 0.94% versus 2.28% (P < 0.0001), the rate of deep incisional SSI was 0.56% versus 1.11% (P = 0.018), and the rate of organ space SSI was 1.06% versus 1.72% (P = 0.031), respectively. The most common pathogens causing SSIs after radical resection of colon carcinoma were Escherichia coli (21/38) and Pseudomonas aeruginosa (5/38). Escherichia coli (24/65) and Enterococcus spp. (14/65) were the two most common pathogens in the rectal group. The multivariate logistic regression analysis showed that only the operating time and number of hospital beds were common independent risk factors for SSIs after the two types of surgery.ConclusionThis multicenter study showed that there were significant differences in the incidence of SSIs, three types of SSIs, and some risk factors between radical resection of colon carcinoma and rectal carcinoma.
Highlights
Colorectal surgery is associated with high rates of surgical site infection (SSI)
We performed multicenter surveillance of radical resection of colon and rectal carcinoma in 26 hospitals [codes of procedures and diseases were restricted in detail according to the International Classification of Diseases, 9th revision; Clinical Modification of Operations and Procedures (ICD-9-CM-3) and International Classification ofDiseases,10th revision (ICD-10), respectively]
Incidence and type of SSI In total, 5729 patients were enrolled for the two types of surgery, and SSI occurred in 206 patients
Summary
Colorectal surgery is associated with high rates of surgical site infection (SSI). The occurrence of surgical site infection (SSI) can lead to psychological trauma, prolong postoperative recovery, and increase the disease burden and mortality. Postoperative SSI is one of the most common complications of radical resection of colorectal carcinoma, and the incidence reportedly ranges from 8 to 30% in different studies [1, 2].The Japanese researcher Tsuyoshi Konishi [3] suggested that for colorectal surgery, a distinction should be made between colonic and rectal surgery because of the differences in the incidence of SSI, infection types, and specific risk factors. The occurrence of most SSIs is preventable; multicenter SSI surveillance and evaluation protocols that distinguish the type of surgery and disease are necessary in the field of colorectal surgery. Few multicenter surveillance studies of infections in colorectal surgery have been carried out in China. We report the incidence of and main risk factors for SSIs in radical resection of colon and rectal carcinoma in China to improve prevention and control of SSIs in these operations
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