Independent Risk Factors For Surgical Site Infection Research Articles

The incidence and risk factors for surgical site infection in older adults after gastric cancer surgery: A STROBE-compliant retrospective study.

Surgical site infection (SSI) is a well-known complication in older adults. However, there have been no studies on SSI after gastrectomy in older adults. Therefore, we aimed to investigate the incidence, risk factors, and outcomes of SSIs after gastrectomy in older adults.We performed a retrospective cohort study of older adults, aged 65 years or older, who underwent gastrectomy between January 2015 and December 2015 at the Severance Hospital in Seoul, Korea. The incidence and outcomes of SSIs after gastrectomy were evaluated, and the risk factors for SSI were identified using multivariate analyses.We identified 353 older adults who underwent gastrectomy. Of these, 25 patients (7.1%) developed an SSI. Multivariate analysis indicated that open surgery (odds ratio, 2.71; 95% confidence interval, 1.13–6.51; P = .03) and a longer operation time (odds ratio, 1.01; 95% confidence interval, 1.00–1.01; P = .04) were independent risk factors for SSI after gastrectomy. In the SSI group, the incidence of postoperative fever (84.0% vs 51.8%; P < .001), length of postoperative hospital stay (13 days vs 6 days; P < .001), and re-admission rates within 30 days postoperatively (32.0% vs 3.4%; P < .001) were significantly higher than those in the non-SSI group.The risk factors for SSI in older adults after gastrectomy were open surgery and a longer operation time. When an SSI occurred, the postoperative hospital stay was prolonged and the chances of having a postoperative fever and being re-admitted within 30 days increased.

Abdomen Depth and Rectus Abdominis Thickness Predict Surgical Site Infection in Patients Receiving Elective Radical Resections of Colon Cancer.

Background: Surgical site infection (SSI) hampers the advantages of surgical management, which requires early forecast particularly in patients receiving colorectal surgery. This study is to explore potential relationship between individual abdominal anatomic characteristics including subcutaneous fat thickness (SFT), rectus abdominis thickness (RAT), and abdomen depth (AD), with the incidence of SSI in elective radical resection of colon malignancy.Materials and Methods: This retrospective case-control study has recruited 55 patients in each SSI and non-SSI group with propensity score match method. Demographics, clinical attributes, and pre- and intra-operative information were compared between groups with univariate analysis to elicit significant parameters, which were subsequently brought into logistic regression and receiver-operating characteristic (ROC) analysis.Results: Patients with SSI showed lower preoperative albumin (p = 0.0022), higher RAT (p = 0.014), AD (p = 0.029), and the multiplied value (RAT × AD) (p = 0.0026) contrasted with patients without SSI. Logistic regression demonstrated RAT × AD as an independent risk factor for SSI (OR = 1.007, p < 0.001) and a biomarker for SSI prediction (AUC = 0.83, 95% CI: 0.74 ~ 0.91).Conclusions: Preoperative RAT and abdomen depth are associated with the risk of postoperative SSI in patients receiving elective radical resection of colon cancer.Trial Registration: www.researchregistry.com, identifier researchregistry3669

Preoperative Hypoglycemia Increases Infection Risk After Trigger Finger Injection and Release.

Diabetes mellitus is a well-known risk factor for infection after trigger finger (TF) injection and/or release. However, the effect of preoperative hypoglycemia before TF injection or release is currently unknown. The purpose of this study is to determine the effects of preoperative hypoglycemia on infection incidence after TF injection or release. A retrospective cohort review between 2007 and 2015 was conducted using a national private payer database within the PearlDiver Supercomputer. Preoperative, fasting, glucose levels were collected for each patient, and these ranged from 20 to 219 mg/dL. Surgical site infection (SSI) rates were determined using International Classification of Diseases, Ninth Revision codes. The query of the PearlDiver database returned 153,479 TF injections, of which 3479 (2.27%) and 6276 (4.09%) had infections within 90 days and 1 year after procedure, respectively. There were 70,290 TF releases identified, with 1887 (2.68%) SSIs captured within 3 months after surgery and 3144 (4.47%) within 1 year after surgery. There was a statistically significant increase in SSI rates in patients with hypoglycemia within 90-day (P = 0.006) and 1-year (P < 0.001) time intervals post-TF injection. Likewise, a statistically significant increase in SSI rate in patients with hypoglycemia undergoing TF release within 1 year after release was seen (P = 0.003). Hypoglycemia before TF injection or release increases the risk for SSI. Tight glycemic control may be warranted to mitigate this risk. Further studies are needed to investigate the effect of hypoglycemia as an independent risk factor for SSI.

Multicenter surveillance study of surgical site infection and its risk factors in radical resection of colon or rectal carcinoma

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.

Risk Factors for Early Infection in Pediatric Spinal Deformity Surgery: A Multivariate Analysis

Study DesignRetrospective case-control study. ObjectivesTo identify risk factors for early deep surgical site infections (SSIs; within three months of index procedure) following pediatric spinal deformity surgery. BackgroundDeep surgical site infections (SSIs) following pediatric spinal deformity surgery are a source of significant morbidity. We sought to identify independent risk factors for early infection following primary, definitive single-stage pediatric posterior spinal fusion and instrumentation (PSFI). MethodsA total of 616 consecutive patients (2001–2016) from an institutional prospectively maintained Pediatric Orthopaedic Spine database were identified that met inclusion criteria of definitive single-stage PSFI. Early deep SSI was defined as infection within three months of index procedure requiring surgical intervention. A multivariate analysis of demographics, comorbidities, and perioperative factors was performed and independent risk factors were identified. ResultsEleven patients (1.6%) developed an early deep SSI. Independent risk factors for SSI identified were nonidiopathic (neuromuscular, syndromic, and congenital) etiologies of scoliosis (adjusted odds ratio [aOR]: 8.384, 95% confidence interval [CI]: 1.784-39.386, p = .007) and amount of intraoperative crystalloids (aOR: 1.547 per additional liter of fluid, 95% CI: 1.057-2.263, p = .025). Mean crystalloid administered in the SSI group was 3.3 ± 1.2 L versus 2.4 ± 1.0 L in the noninfected group (p = .019). On univariate analysis, there was no significant difference in weight of patients between cohorts (p = .869) or surgery time (p = .089). There was also no significant difference in infection rates from redosing of antibiotics intraoperatively after 3 hours of surgery (p = .231). ConclusionsNonidiopathic scoliosis and amount of intraoperative crystalloids were independently associated with early postoperative SSI. Further investigation into intraoperative fluid management may identify modifiable risk factors for early postoperative SSI in primary pediatric spinal deformity posterior spinal fusion patients. Level of EvidenceLevel III, case-control study.

A High Visceral-To-Subcutaneous Fat Ratio is an Independent Predictor of Surgical Site Infection after Gastrectomy.

Recent studies have shown that body composition is an important factor that affects surgical site infection (SSI). However, each study has utilized different body composition criteria. Therefore, in this study, we aim to determine the most predictable body composition criteria for the prediction of SSI after gastrectomy. The visceral fat area (VFA), subcutaneous fat area (SFA), and muscle area were assessed by a preoperative-stage computed tomographic (CT) scan. To compare the predictive performance of body composition for SSI, logistic regression models were used, and the models were compared using the receiver operation characteristic (ROC) curve and the area under the curve (AUC) value. Of the 1038 eligible patients, 58 patients (5.6%) developed SSI. The VFA-to-SFA ratio showed the best predictive performance (mean AUC 75.11). The cutoff value for the SSI of the VFA-to-SFA ratio was 0.94, and the sensitivity and specificity were 67.86% and 77.65%, respectively. A multivariate logistic analysis indicated that a total gastrectomy (OR, 2.13; p = 0.017), stage III or IV cancer (OR, 2.66; p = 0.003), and a high VFA-to-SFA ratio (OR, 8.09; p < 0.001) were independent risk factors for SSI after gastrectomy. The VFA-to-SFA ratio is the most predictable body composition model for use in predicting the incidence of SSI after gastrectomy.

Surgical site infection following abdominal surgery: a prospective cohort study

Surgical site infection (SSI) is one of the most common complications of abdominal surgery and is associated with substantial discomfort, morbidity and cost. The goal of this study was to describe the incidence, bacteriology and risk factors associated with SSI in patients undergoing abdominal surgery. In this prospective cohort study, all patients aged 14 years or more undergoing abdominal surgery between Feb. 1 and July 31, 2016, at a single large academic hospital were included. Patients undergoing vascular, gynecological, urological or plastic procedures were excluded. Patients were followed prospectively for 30 days. Wound assessment was done with the Centers for Disease Control and Prevention definition of SSI. We performed multivariate analysis to identify factors associated with SSI. A total of 337 patients were included. The overall incidence of SSI was 16.3% (55/337); 5 patients (9%) had deep infections, and 25 (45%) had combined superficial and deep infections. The incidence of SSI in open versus laparoscopic operations was 35% versus 4% (p < 0.001). The bacteria most commonly isolated were extended-spectrum β-lactamase-producing Escherichia coli, followed by Enterococcus species. Only 23% of cultured bacteria were sensitive to the prophylactic antibiotic given preoperatively. The independent predictors of SSI were open surgical approach, emergency operation, longed operation duration and male sex. Potentially modifiable independent risk factors for SSI after abdominal surgery including open surgical approach, contaminated wound class and emergency surgery should be addressed systematically. We recommend tailoring the antibiotic prophylactic regimen to target the commonly isolated organisms in patients at higher risk for SSI.

Surgical site infection incidence and risk factors in thoracic surgical procedures: A 12-year prospective cohort study.

Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures. During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI. We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified: wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI): 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR: 1.795; 95% CI: 1.136-2.834), duration of drainage (p < 0.001; RR: 1.117; 95% CI: 1.085-1.150), age (p = 0.036; RR: 1.018; 95% CI: 1.001-1.035) and duration of operation (p < 0.001; RR:1.005; 95% CI:1.002-1.008). The results are valuable in documenting risk factors for SSI in patients undergoing thoracic surgery. The knowledge and prevention of controllable risk factors is necessary in order to reduce the incidence of SSI.

Modifiable Factors as Current Smoking, Hypoalbumin, and Elevated Fasting Blood Glucose Level Increased the SSI Risk Following Elderly Hip Fracture Surgery

Objective: Surgical site infection (SSI) following hip fractures represents an important complication. This study aimed to investigate the incidence rate after surgery of hip fractures in the elderly and to identify the associated risk factors. Patients: Patients’ demographic, injury, and surgery-related data and biochemical indexes were retrospectively reviewed and recorded during their hospitalization, between July 2015 and June 2017. After their discharge from hospital, patients were prospectively followed up at postoperative 1, 3, 6, and 12 months. SSIs were identified by review of patients’ medical records and post-discharge telephone follow-up. Univariate and multivariate analyses were performed to determine the independent risk factors associated with SSI. Results: A total of 611 patients undergoing surgery for hip fractures with complete data were included for analysis. During the postoperative one year, 27 SSIs (19 superficial and 8 deep SSIs) developed, indicating the cumulative incidence of 4.4% (95%CI, 2.8–6.0%). Of them, 21 (77.8%) SSIs were detected during patients’ hospitalization, and the 6 (22.2%) cases were confirmed via telephone during the post-discharge follow-up. After adjustment of multiple variables, BMI, current smoking, surgical duration, preoperative hospital stay, ASA class of III-IV, ALB <35g/L, and FBG > 110mg/dL were identified as independent risk factors for SSI. Conclusions: Three modifiable factors as smoking, preoperative ALB <35g/L, and FBG > 110mg/dL should be optimized preoperatively to reduce the SSIs. Other factors, although not modifiable, could be used for screening of at-risk patients, patient risk stratification, or for counseling of patients.

68: Surgical site infection after laparoscopic hysterectomy

To compare 30-day risk of deep/organ space and superficial incisional surgical site infections (SSI) by sub-type of laparoscopic hysterectomy. To report on additional risk factors for SSI following laparoscopic hysterectomy. Using the American College of Surgeons National Surgical Quality Improvement Program’s Database, we identified women undergoing laparoscopic hysterectomy between 2012-2014 using CPT codes. Women were stratified into 3 groups by type of hysterectomy: total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and laparoscopic supracervical hysterectomy (LSCH). Group comparisons were made using ANOVA and X2 test. Univariate analysis was performed using Student’s t-test, X2 test or Fisher’s exact test. Significant variables on univariate analysis were included in a stepwise backward multivariable logistic regression to identify independent risk factors for SSI. A total of 52,786 women were included. Mean (±SD) age and BMI were 49 ± 12years and 31 ± 8kg/m2; 74% were white. There were 31,070 (59%) hysterectomies classified as TLH, 14,796 (28%) were LAVH, and 6,920 (13%) were LSCH. Mean operative times were shortest for LAVH, and longest for LSCH (130 ± 63 mins and 154 ± 79 mins, respectively; p < 0.001). The 30-day deep/organ space SSI was lower for LSCH (0.6%) than for TLH (1.0%) or LAVH (1.1%) (p = 0.001), but there was no difference in occurrence of superficial incisional SSI: 0.8%, 0.8%, and 0.8% for TLH, LAVH, and LSCH, respectively (p=0.54). On univariate analysis, type of hysterectomy, increasing age, race, smoking, diabetes, preoperative steroid use, dialysis, gynecologic malignancy, ASA class, operative time, peri-operative transfusion, hospital length of stay and wound classification were associated with deep/organ space SSI. On multivariate analysis after controlling for confounders, LSCH remained independently associated with a decreased risk of deep/organ space SSI (aOR 0.59, 0.42-0.83). Conversely, relative to women who were discharged within 24hrs, women admitted for greater than 1 day had a 2-fold increase in deep/organ space SSI (aOR 2.13 (1.56-2.91). Asian race (aOR 1.89, 1.28-2.77), smoking (aOR, 1.45, 1.18-1.79), gynecologic malignancy (aOR, 1.42, 1.05-1.91), perioperative transfusion (aOR 1.94, 1.26-2.99), preoperative steroid use (aOR 1.83, 1.08-3.10), dirty/infected cases (aOR 26.04, 7.31-92.73), and preoperative dialysis (aOR 4.11, 1.20-14.06), were independently associated with increased odds for deep/organ space SSI. Smoking (aOR 1.29, 1.02-1.65) and length of stay greater than 1 day (aOR 1.62, 1.16-2.25) increased the risk of superficial incisional SSI. Laparoscopic supracervical hysterectomy is associated with a decreased risk of deep/organ space SSI compared to other sub-types of laparoscopic hysterectomy. Same-day discharge is protective against SSI.

Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors.

The purposes of this study were to investigate the incidence of surgical site infection (SSI) following geriatric elective orthopaedic surgeries and identify the associated risk factors This was a retrospective two-institution study. Between January 2014 and September 2017, patients aged 60 years or older undergoing elective orthopaedic surgeries were included for data collection and analysis. SSI was identified through the review of patients' medical records for the index surgery and through the readmission diagnosis of SSI. Patients' demographics, characteristics of disease, surgery-related variables, and laboratory examination indexes were inquired and documented. Univariate and multivariate logistic analyses were performed to determine independent risk factors for SSI. There were 4818 patients undergoing elective orthopaedic surgeries, and within postoperative 1 year, 74 patients were identified to develop SSIs; therefore, the overall incidence of SSI was 3.64%, with 0.4% for deep and 1.1% for superficial infection. Staphylococcus aureus (25/47, 53.2%) and coagulase-negative staphylococci (11/47, 23.4%) were the most common causative pathogens; half of S. aureus SSIs were caused by Methicillin-resistant Staphylococcus aureus (MRSA) (12/25, 48.0%). Five risk factors were identified to be independently associated with SSI, including diabetes mellitus (odds ratio [OR], 3.7; 95% confidence interval [95% CI], 1.7-5.6), morbid obesity (OR, 2.6; 95% CI, 1.3-3.9), tobacco smoking (OR, 4.2; 95% CI, 2.1-6.4), surgical duration>75th percentile (OR, 1.9; 95% CI, 1.0-2.9), and ALB < 35.0 g/L (OR, 2.3; 95% CI, 1.3-3.4). We recommend the optimisation of modifiable risk factors such as morbid obesity, tobacco smoking, and lower serum albumin level prior to surgeries to reduce the risk of SSI.

Risk factors for surgical site infection after malignant bone tumor resection and reconstruction

BackgroundUse of an implant is one of the risk factors for surgical site infection (SSI) after malignant bone tumor resection. We developed a new technique of coating titanium implant surfaces with iodine to prevent infection. In this retrospective study, we investigated the risk factors for SSI after malignant bone tumor resection and to evaluate the efficacy of iodine-coated implants for preventing SSI.MethodsData from 302 patients with malignant bone tumors who underwent malignant bone tumor resection and reconstruction were reviewed. Univariate analyses were performed, followed by multivariate analysis to identify risk factors for SSI based on the treatment and clinical characteristics.ResultsThe frequency of SSI was 10.9% (33/302 tumors). Pelvic bone tumor (OR: 4.8, 95% CI: 1.8–13.4) and an operative time ≥ 5 h (OR: 3.4, 95% CI: 1.2–9.6) were independent risk factors for SSI. An iodine-coated implant significantly decreased the risk of SSI (OR: 0.3, 95% CI: 0.1–0.9).ConclusionThe present data indicate that pelvic bone tumor and long operative time are risk factors for SSI after malignant bone tumor resection and reconstruction, and that iodine coating may be a promising technique for preventing SSI.

Predicting surgical site infections using a novel nomogram in patients undergoing hepatectomy

Introduction: Surgical site infections (SSI) remain a major cause of morbidity after hepatectomy for Hepatocellular Carcinoma (HCC). Here, we aimed to identify the risk factors associated with SSI, and develop a novel nomogram to predict SSI among patients undergoing hepatectomy. Method: We retrospectively reviewed the data of 640 patients diagnosed with HCC undergoing hepatectomy at two academic institutions from April 2012 to March 2018, and evaluated the occurrence of SSI. Independent risk factors for SSI were identified using univariate and multivariate analysis. Based on these independent risk factors, a nomogram was established using data of patients in the first institution and was validated in an external independent cohort from the second institution. Result: The nomogram was established using data from 309 patients while the validation cohort consisted of 331 patints. Duration of operation, hypoalbuminemia, repeat hepatectomy, bile leakage were identified as independent risk factors. The C-index of the nomogram for SSI prediction in the training cohort was 0.86; this nomogram also performed well in the external validation cohort, with a C-index of 0.81. Accordingly, we stratified patients into 3 groups, with a distinct risk range based on the nomogram prediction, to guide clinical practice. Conclusion: Our novel nomogram offers good preoperative prediction for SSIs in HCC patients undergoing hepatectomy.

Surgical site infection after penetrating abdominal trauma with bowel involvement: a comparison between HIV-seropositive and seronegative patients

The influence of HIV-infection on surgical site infection (SSI) after surgery for penetrating abdominal trauma is not investigated and therefore not as yet elucidated. This prospective study was performed with the aim to compare the SSI rate in human immunodeficiency virus (HIV)-seropositive and HIV-negative patients and to identify other risk factors for this abdominal wound complication. 98 patients who underwent small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma were included in the study. Injury related factors as well as demographical and physiological parameters, including HIV-status were analysed and superficial and deep SSI incidence rates were evaluated. Of the 98 patients, 23 patients (23%) were HIV-seropositive. The overall superficial SSI rate was 45% and the deep SSI rate was 15%. No significant difference in SSI (superficial or deep) in the HIV-seropositive and -negative group was demonstrated (superficial SSI HIV-pos vs HIV-neg: 61% vs 40%; p=0.172, deep SSI 22% vs 13%, p=0.276). Multivariate analysis identified five independent risk factors for SSI: postoperative CD4 count < 250 cells/μl, postoperative albumin < 30 g/L, relook operation, anastomotic leak and colonic anastomosis. HIV-infection is not an independent risk factor for developing SSI after penetrating abdominal trauma. Low postoperative CD4 count, irrespective of HIV status, low postoperative albumin, relook operation, anastomotic leak and colonic anastomosis are predictors for SSI irrespective of the HIV-serostatus. These factors should be considered in unison during the decision-making process of abdominal wound closure; planned secondary wound treatment or immediate application of negative pressure dressings in patients with a high-risk profile may decrease the hospital stay and the financial burden on the health care system.

Type of Pelvic Disease as a Risk Factor for Surgical Site Infectionin Women Undergoing Hysterectomy

To quantify the relationship between type of benign pelvic disease and risk of surgical site infection (SSI) after hysterectomy. Retrospective cohort study (Canadian Task Force classification II-2). Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Women who underwent hysterectomy from 2006-2015 and recorded in NSQIP database. None. SSI risk was compared for type of benign pelvic disease, patient characteristics (i.e., age, race, and selected comorbidities) and process of care variables (i.e., admission status, type of hysterectomy, and operative time). SSI occurred in 2.48% of the 125,337 women who underwent hysterectomy. SSI was most frequent in patients with endometriosis and least frequent in those with genital prolapse (3.13% vs 1.39%; p <.0001). Following adjustment for potential confounders, the odds of SSI were higher in women undergoing hysterectomy for endometriosis (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.43- 2.25), uterine myomas (aOR, 1.28; 95% CI, 1.05-1.55), menstrual disorders (aOR, 1.46; 95% CI, 1.20-1.78), and pelvic pain (aOR, 1.75; 95% CI, 1.34-2.27) compared with women undergoing hysterectomy for genital prolapse. Other patient factors associated with SSI included age, body mass index, smoking, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and American Society of Anesthesiologists classification. Among process-of-care factors, inpatient status, route of hysterectomy, total vs subtotal hysterectomy, and operative time were also associated with SSI. In addition to various patient and process-of-care factors known to be associated with SSI, type of underlying pelvic disease is an independent risk factor for SSI in women undergoing hysterectomy for benign indications.

2130. Impact of Sarcopenic Obesity on Surgical Site Infection After Gastric Cancer Surgery: A Retrospective Study of 1,038 Patients

BackgroundRecent studies have shown that body composition is an important factor affecting surgical outcomes. In this study, we investigate the effect of sarcopenic obesity on surgical site infection (SSI) after gastric cancer surgery.MethodsWe performed a retrospective cohort study of 1,038 patients who underwent gastric cancer surgery between January 2015 and December 2015 at tertiary care hospital in Seoul, Korea. Visceral fat area (VFA) and total abdominal muscle area (TAMA) were assessed at preoperative staging computed tomography scan. Sarcopenic obesity was defined as high VFA/TAMA ratio and receiver operating characteristic (ROC) curves were used to determine the threshold of VFA/TAMA ratio to predict SSI after gastric cancer surgery. Multivariate logistic regression analysis was used to identify independent risk factors for SSI.ResultsOf the 1,038 eligible patients, 58 patients (5.6%) developed SSI. The average value of VFA/TAMA is 2.69 ± 1.43 in non-SSI group and 3.38 ± 1.34 in SSI group (P < 0.001). By using ROC curve, the cut-off value of VFA/TAMA to predict SSI is 3 (AUC 0.653; sensitivity 67%, specificity 61%). Multivariate analysis indicated that smoking (odds ratio (OR), 1.99; 95% confidence interval (CI), 1.1–3.62; P = 0.024), total gastrectomy (OR, 2.45; 95% CI, 1.36–4.42; P = 0.003), stage III, IV cancer (OR, 2.58; 95% CI, 1.44–4.63; P = 0.001) and sarcopenic obesity (OR, 2.85; 95% CI, 1.6–5.06; P < 0.001) were independent risk factors for SSI after gastric cancer surgery. In sarcopenic obesity patients, the incidence rate of Clavien–Dindo score IIIa or higher postoperative complication (7.1% vs. 4%; P = 0.028), mean days of postoperative hospital stay (8.42 ± 7.93 vs. 7.12 ± 3.54; P < 0.001), and the incidence rate of delayed complications requiring re-admission within 30 days (6.1% vs. 2.7%; P = 0.007) were statistically significantly higher than those of the nonsarcopenic obesity patients.ConclusionSarcopenic obesity is an independent risk factor for the development of SSI after gastric cancer surgery. In addition, sarcopenic obesity is associated with high incidence of postoperative complication, prolongation of postoperative hospital stay and an increase of re-admission rate within 30 days.Disclosures All authors: No reported disclosures.

Risk factors for surgical site infection after cesarean delivery: A case-control study

The cesarean delivery (CD) rate is increasing worldwide. Surgical site infection (SSI) incidence is likely to follow an upward trajectory. We examined the incidence and risk factors for SSI after CD. A case-control study of women who had a lower-segment CD during the study period was performed at Ireland's Cork University Maternity Hospital. Cases were patients who presented to the hospital with SSI and who met the criteria of the U.S. Centers for Disease Control and Prevention. Controls were randomly selected from the discharge register of CDs at a ratio of 2:1. Data were extracted from the medical records. A multivariable stepwise logistic regression model approach was used, and the results were expressed as adjusted odds ratios (aORs). The SSI rate was 2%. The greatest contribution to risk of SSI was associated with maternal obesity (aOR, 4.76; 95% confidence interval [CI], 2.00-11.32) and hypertensive disorders (aOR, 6.67; 95% CI, 1.54-28.99]. There was also an increased risk for women who underwent an emergency CD (aOR, 3.50; 95% CI, 1.09-11.30), for women who had ≥5 vaginal examinations (aOR, 3.24; 95% CI, 0.92-11.41), and for women without hypertensive disorders who delivered a baby weighing <3,500 g (aOR, 2.18; 95% CI, 1.08-4.37). Obesity, hypertensive disorders, emergency CD, and multiple vaginal examinations were independent risk factors for SSI after CD.

Effect of Post-cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women: A Randomized Clinical Trial

(JAMA 2017;318(11):1026–1034) Previous studies estimated 3% to 12% of all cesarean deliveries in the United States are complicated by surgical site infection (SSI). This risk increases as maternal weight increases, and despite preoperative antibiotic regimens, obesity is an independent risk factor for SSI. While standard care has been the use of preoperative cephalosporin antibiotics, other antibiotic combinations have been studied. However, conflicting benefits have been found and none of these studies focused specifically on obese women. In this study, the effects of an additional 48-hour course of postoperative prophylactic oral cephalexin plus metronidazole was compared with the current standard of care (preoperative intravenous cephalosporin alone) in obese women who delivered via cesarean section.

Contaminated or dirty wound operations and methicillin-resistant Staphylococcus aureus (MRSA) colonization during hospitalization may be risk factors for surgical site infection in neonatal surgical patients.

Establishment of evidence-based best practices for preventing surgical site infection (SSI) in neonates is needed. SSI in neonates, especially those with a low birth weight, is potentially life-threatening. We aimed to identify risk factors associated with SSI in neonates. A retrospective review was performed using 2007-2016 admission data from our institution. Neonatal patients who were admitted to the neonatal intensive care unit and underwent surgery were evaluated for a relationship between development of SSI and perinatal or perioperative factors and methicillin-resistant Staphylococcus aureus (MRSA) colonization during hospitalization. One hundred and eighty-one patients were enrolled in this study. Overall SSI incidence was 8.8%. Univariate analysis showed that SSI was significantly more frequent in both patients with contaminated or dirty wound operations and patients with MRSA colonization during hospitalization. Both of these factors were identified as independent risk factors for SSI by multivariate analysis [hazard ratio (HR): 6.1, 95% confidence interval (CI) 2.0-19.9; HR: 3.3, 95% CI 1.1-10.4, respectively]. This study identified contaminated or dirty wound operations and MRSA colonization during hospitalization as risk factors for SSI in neonates. MRSA colonization may be a preventable factor, unlike previously reported risk factors.

Risk factors for surgical site infection after kidney and pancreas transplantation.

To evaluate the incidence of surgical site infection (SSI) in a cohort of pancreas transplant recipients and assess predisposing risk factors for SSI DESIGN: Retrospective cohort study SETTING: Single transplant center in CanadaPatientsPatients who underwent any simultaneous pancreas and kidney (SPK) or pancreas after kidney (PAK) transplant procedures between January 2000 and December 2015 METHODS: In this retrospective cohort evaluation of SPK or PAK recipients, we assessed the incidence of SSI and risk factors associated with superficial, deep, and organ/space SSI. Multivariate logistic regression was used to identify independent risk factors for SSI in SPK and PAK recipients. In total, 445 adult transplant recipients were enrolled. The median age of these patients was 51 years (range, 19-71 years), and 64.9% were men. SSIs were documented in 108 patients (24.3%). Organ/space SSIs predominated (59 patients, 54.6%), followed by superficial SSIs (47 patients, 43.5%) and deep SSIs (3 patients, 2.8%). Factors predictive of SSIs in the multivariate analysis were cold pancreas ischemic time (odds ratio [OR], 1.002; P=.019) and SPK transplant (compared to PAK transplant recipients; OR, 2.38; P=.038). Patients with SSIs developed graft loss more frequently (OR, 16.99; P<.001). Organ/space SSIs remain a serious and common complication after SPK and PAK. Prolonged cold ischemic time and SPK transplant were the risk factors predictive of SSIs. Appropriate perioperative prophylaxis in high-risk patients targeting the potential pathogens producing SSIs in kidney and/or pancreas transplant recipients and a reduction in cold ischemia may prove beneficial in reducing these SSIs.