Risk Factors and the Prevention of Incisional Surgical Site Infections in Patients With Colorectal Perforation

Abstract

Introduction: Incisional surgical site infection (SSI) is one of the most frequent complications that occur after colorectal surgery. Surgery for colorectal perforation carries an especially high risk of incisional SSI because the incisional wound exposes the ascites to fecal contamination. Although the risk factors of incisional SSI after elective and emergent colorectal surgery have been analyzed, no study has focused exclusively on emergency surgery for colorectal perforation. Methods: Patients with colorectal perforation who underwent emergent surgery from 2010 to 2015 at our institution were consecutively enrolled in the study and evaluated according to the presence or absence of an incisional SSI. The factors associated with the occurrence of postoperative incisional SSI were evaluated. Factors identified as significant in the univariate analyses were included in the multivariate regression models. To ensure robustness, we added in the factors that clinically indicated severe peritonitis and sepsis. In addition, in March 2013, we developed an incisional SSI prevention protocol for patients undergoing stoma creation. The effectiveness of the protocol in these patients was determined and the rates of incisional SSI between before and after March 2013 were compared. Results: The mean age of the 95 study patients at surgery was 70 ± 13 years; 48 (51%) were male. The incisional SSI group comprised 26 patients (27%). Postoperative hospital stay was significantly longer in this group than in the SSI-negative group (37 vs. 15 days respectively; p < 0.001). Multivariate logistic regression analysis showed that stoma creation (odds ratio, 11.34; 95% confidence interval, 2.056-214.142; p=0.003) was an independent risk factor for incisional SSI. In a subgroup analysis of the patients who underwent stoma creation, the rate of incisional SSI was significantly lower after implementation of the incisional SSI prevention protocol (43% vs. 20% respectively; p=0.049). Conclusion: Stoma creation was an independent risk factor for postoperative incisional SSI in patients with colorectal perforation. Previous studies also identified stoma creation as a risk factor for incisional SSI after colorectal surgery. Our results demonstrated the effectiveness of our incisional SSI prevention protocol in patients undergoing stoma creation. The use of cyanoacrylate tissue adhesive (Dermabond) creates a barrier against the penetration of microorganisms, and thus prevents the development of an incisional SSI.Table 1: Comparison of the characteristics of patients with (SSI) and without (No SSI) surgical site infectionTable 2: Multiple logistic regression analysis for risk factors of incisional SSI after surgery for colorectal perforationFigure 1Figure 2