Abstract
AimThe objectives were to recognize the risk factors for surgical site infections (SSIs) after surgery due to colorectal cancer and to assess the impact of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (ABX) on SSIs.MethodsRecords from two colorectal centers were used. Risk factors of SSIs were categorized into patient-, disease-, and treatment-dependent.ResultsA group of 2240 patients was included. SSIs were noted in 364 patients (16.3 %). MBP+/ABX+ was connected with a lower incidence of anastomotic leak (AL) and organ-space SSIs: 2.4 vs. 6.3 %; p = 0.008 and 3.6 vs. 7.2 %; p = 0.017, respectively. Patient-dependent factors: obesity increased the risk of skin superficial SSIs, adjusted OR 1.53 (1.47–1.59 95 % confidence interval (95 % CI)), and deep incisional SSIs 1.42 (1.39–1.45 95 % CI). Disease-dependent factors: rectal cancer was associated with a higher risk of skin superficial and deep incisional SSIs, adjusted OR 1.28 (1.22–1.34 95 % CI) and 1.13 (1.09–1.15 95 % CI). Treatment-dependent factors: MBP+/ABX+ was associated with a lower risk of organ-space SSIs, adjusted OR 0.53 (0.44–0.59 95 % CI). Radiotherapy increased the risk of organ-space SSIs, adjusted OR 1.78 (1.75–1.80 95 % CI). The risk of organ-space SSIs was the highest after low anterior resection, adjusted OR 1.62 (1.60–1.64 95 % CI).ConclusionsIf possible, MBP and ABX should always be administered to decrease the risk of AL and organ-space SSIs. Factors strictly related to the treatment mostly increased the risk of organ-space SSIs.
Highlights
Surgical site infections (SSIs) are commonly diagnosed as postoperative complications related to all abdominal operations with an estimated rate of 26 %
If possible, mechanical bowel preparation (MBP) and antibiotic prophylaxis (ABX) should always be administered to decrease the risk of anastomotic leak (AL) and organ-space SSIs
Taking into account the type of resection, we revealed that abdominal perineal resection was associated with the highest incidence of SSI compared with all other resections
Summary
Surgical site infections (SSIs) are commonly diagnosed as postoperative complications related to all abdominal operations with an estimated rate of 26 %. The occurrence of SSIs depends on many factors, such as the patient, the disease, the surgeon’s experience and surgical technique, mechanical bowel preparation, and antibiotic prophylaxis. It is difficult to anticipate which group of patients is at a higher risk of SSIs. In the 1970s, the utilization of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (ABX) became a standard preoperative regimen [3]. The data suggest that MBP+ along with ABX+ may reduce the incidence of SSIs compared with the strategy of MBP− and ABX− [9]
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