Abstract
BackgroundSurgical site infections (SSIs) are among the most common healthcare-associated infections. Evaluating risk factors for SSIs among patients undergoing laparoscopic and open colorectal resections can aid in selecting appropriate candidates for each modality.MethodsA cohort of all consecutive patients undergoing elective colorectal resections during 2008–2017 in a single center was analyzed. SSIs were prospectively assessed by infection control personnel. Patient data were collected from electronic medical records. Risk factors for SSIs were compared between patients who underwent laparoscopic and open surgeries. A multivariate analysis was performed for significant variables.ResultsDuring the study period, 865 patients underwent elective colorectal resection: 596 laparoscopic and 269 open surgeries. Mean age was 68.2 ± 15.1 years, weight 72.5 ± 18.3 kg and 441 (51%) were men. The most common indication for surgery was malignancy, in 767 patients (88.7%) with inflammatory bowel diseases and diverticulitis following (4.5% and 3.9%, respectively). Patients undergoing laparoscopic surgery were younger, had fewer comorbidities, shorter pre-operative hospitalizations, lower risk index scores, and lower rates of SSI, compared with open surgery. Independent risk factors for SSI following laparoscopic surgery were chronic obstructive pulmonary disease [odds ratio (OR) 2.655 95% CI (1.267, 5.565)], risk index ≥ 2 [OR 2.079, 95% CI (1.041,4.153)] and conversion of laparoscopic to open surgery [OR 2.056 95%CI (1.212, 3.486)]. Independent risk factors for SSI following open surgery were immunosuppression [OR 3.378 95% CI (1.071, 10.655)], chronic kidney disease [OR 2.643 95% CI (1.008, 6.933)], and need for a second dose of prophylactic antibiotics [OR 2.519 95%CI (1.074, 5.905)].ConclusionsRisk factors for SSIs differ between laparoscopic and open colorectal resections. Knowledge of specific risk factors may inform patient selection for these modalities.
Highlights
Surgical site infections (SSIs) are among the most common healthcare-associated infections
Laparoscopy is an increasingly popular surgical approach for colorectal surgery in general and for colorectal resections in particular, as it is associated with improved post-operative morbidity, lower SSI rates and reduced post-operative mortality rates [7]
SSIs were diagnosed in 197 patients (22.8%), of which 109 (12.6%) were superficial and 26 (3%) were deep wound infections and 59 (6.8%) were organ/space infections
Summary
Surgical site infections (SSIs) are among the most common healthcare-associated infections. Evaluating risk factors for SSIs among patients undergoing laparoscopic and open colorectal resections can aid in selecting appropriate candidates for each modality. Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs), accounting for approximately 20% of HAIs in the United States [1]. The risk for an SSI following colorectal surgery relates both to patient characteristics and to procedure-related factors. Risk factors for SSIs following laparoscopic colorectal resections are not as well described as for an open surgical approach, due to limitations of previous studies, including heterogeneous patient populations and surgical indications, limited sample sizes and inconsistent results [8,9,10]. Data comparing risk factors for SSIs following laparoscopic and open colorectal resections in similar patient populations are lacking
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