Surgical site infection rates: open versus hand-assisted colorectal resections

Abstract

This study was performed to determine impact of open and hand-assisted colorectal resection on surgical site infection (SSI) rates. National Surgical Quality Improvement Project data from 2006 to 2008 were supplemented with an institutional review board-approved chart review. Primary endpoint was SSI rates defined by the Centers for Disease Control National Nosocomial Infections Surveillance system and classified as superficial, deep incisional, and organ space. Inclusion criteria were elective or emergency open or hand-assisted colorectal resections. Wounds were classified as clean-contaminated, contaminated, or dirty-infected. Patients were not included if they underwent laparoscopic colorectal resection, small bowel resection, or stoma creation. Two hundred and forty-five consecutive patients were included over a 29-month period. One hundred and ninety-five open and 50 hand-assisted patients were comparable for gender, body mass index, ethnicity, tobacco addiction, steroid use, type of colorectal resection, operating time, and method of wound closure. Differences in ASA class, wound classification, and preexisting comorbidities resolved when 80 open and 5 hand-assisted patients who underwent emergency resections were excluded from analysis. Rate of stoma creation remained higher in open patients even after excluding emergency cases (p<0.01). Overall SSI rates following open and hand-assisted resections were 28 and 44%, respectively (p=0.015). Superficial SSI rates were higher in hand-assisted patients (20 vs. 40%, p=0.006). Deep (2.1 vs. 4%, p=0.605) and organ space SSI rates (5.1 vs. 0%, p=0.221) did not differ. These results did not change when emergency resections were excluded: overall 28 and 44% (p=0.015), superficial (23 vs. 44%, p=0.009), deep (3.5 vs. 4.4%, p=0.541), and organ space (7 vs. 0%, p=0.066). This study seems to suggest possibly higher rates of incisional SSI in patients who underwent hand-assisted colorectal resection as compared to open. This retrospective study had, however, insufficient power to stratify by surgeon and control for risk factors by logistic regression.