Significant Risk Factors For Surgical Site Infection Research Articles

Surgical site infection after osteotomy of the adult spine: does type of osteotomy matter?

Background context Surgical site infection after spinal surgery is frequently seen. It occurs between 0.7% and 12% of patients, leading to higher morbidity, mortality, and health-care costs. Osteotomy procedures are known to have increased blood losses and surgical times when compared with other spinal surgeries. Both of these factors have previously been identified as significant risk factors for SSI. We performed a cohort study of this high-risk population to identify risk factors and rates of SSI after spinal osteotomy surgery and identify difference in risk between different types of osteotomies. Purpose The objective of the study was to assess the incidence and identify significant risk factors for surgical site infection (SSI) after spinal osteotomy. Study design Retrospective review of all adult patients who underwent spinal osteotomy surgery for deformity by an orthopedic surgeon in our university. Methods All electronic records of adult orthopedic patients whom underwent a spinal osteotomy procedure at our department between January 1998 and December 2005 (n=363) were abstracted. During surgery, a pedicle subtraction osteotomy (transpedicular wedge resection), anterior spine osteotomy (resection of anterior and middle columns), posterior Smith-Petersen osteotomy (resection of a portion of the superior and inferior lamina, ligamentum flavum, and the inferior and superior articular processed), or a combined anterior and posterior osteotomy (vertebral column resection [VCR]) (circumferential resection of the vertebrae via either a combined anterior/posterior or posterior-only approach) was performed. Primary outcome measurement was SSI. Subanalysis to deep and superficial SSI was performed. Results Twenty patients (5.5%) were found to have an SSI, with nine (2.5%) having deep SSI. Analysis showed that patients undergoing VCR (p=.042) had a significant increased risk for deep SSI (11.1%). Obese patients had a significant increased risk (p=.045) for superficial SSI. Conclusions Vertebral column resection has a significant increased risk for SSI (11.1%) compared with other types of osteotomies (4.1%). When possible, osteotomy techniques that involve less extensive exposures and soft-tissue dissection should be chosen to minimize deep SSI risk. Obese patients should be counseled on weight loss to try minimizing superficial SSI risk.

Postoperative surgical site infection following acetabular fracture fixation

Postoperative surgical site infection (SSI) in orthopaedic trauma surgery is uncommon, but can present serious complications. This study was designed to assess the prevalence of, and to identify the risk factors for, SSI following acetabular fracture open reduction and internal fixation. A total of 326 consecutive patients who underwent acetabular fracture surgery were retrospectively reviewed. There were 17 patients (5.2%) who developed a SSI, including 10 deep infections and 7 superficial infections. Staphylococcus aureus was the most common causative pathogens in 9 patients, and was Methicillin-resistant in 3 patients. Enterococcus faecalis was found in 6 patients, Staphylococcus epidermidis in 3 patients, and Pseudomonas aeruginosa and enterbacter cloacae in 2 patients each. Fourteen of 17 patients developed their infection within 4 weeks after the fixation. Univariate analysis demonstrated that the SSI group had statistically significant higher Injury Severity Score, longer intensive care unit (ICU) stays, larger amount of packed red blood cells transfused, longer operative time, larger estimated operative blood loss, higher body mass index (BMI), more frequent performance of combined approach, embolisation of internal iliac arteries, association of urinary tract injury, and Morel-Lavallée lesion compared to the no SSI group. Multivariate analysis using these 10 parameters showed that BMI, ICU stay, and Morel-Lavallée lesion were independently significant risk factors for SSI. To reduce the incidence of SSI following acetabular fracture surgery, special attention should be directed at the care of obese patients, patients requiring ICU care, and patients with associated Morel-Lavallée lesions.

Incidence, Prevalence, and Analysis of Risk Factors for Surgical Site Infection Following Adult Spinal Surgery

A retrospective cohort study to identify rates and analyze the risk factors for postoperative spinal wound infection. To determine significant risk factors for postoperative spinal wound infection by comparing those patients who developed a postoperative wound infection with the rest of the cohort. A surgical site infection (SSI) is a common complication after spinal surgery. SSI leads to higher morbidity, mortality, and healthcare costs. To develop strategies to reduce the risk for SSI, independent risk factors for SSI should be identified. The electronic patient record of all 3174 patients who underwent orthopedic spinal surgery at out institution were abstracted. Individual patient and perioperative characteristics were stored in an electronic database. In total, 132 (4.2%) patients were found to have an SSI with 84 having deep based infection. Estimated blood loss over 1 liter (P = 0.017), previous SSI (P = 0.012) and diabetes (P = 0.050) were found to be independent statistically significant risk factors for SSI. Obesity (P = 0.009) was found to significantly increase the risk of superficial infection, whereas anterior spinal approach decreased the risk (P = 0.010). Diabetes (P = 0.033), obesity (P = 0.047), previous SSI (P = 0.009), and longer surgeries (2-5 hours [P = 0.023] and 5 or more hours [P = 0.009]) were found to be independent significant risk factors for deep SSI. SSI is commonly seen after spinal surgery. In our study, we identified independent risk factors for both deep and superficial SSI. Identification of these risk factors should allow us to design protocols to decrease the risk of SSE in future patients.

Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon, and gastric surgery

Surgical site infection (SSI) is an important clinical indicator of quality of patient care and infection control; therefore, we aimed to assess risk factors SSI in colon and gastric surgeries. SSI was assessed according to the National Nosocomial Infection Surveillance (NNIS) system (1999). Risk factors examined included operative approach, operative procedure, duration of operation, diabetes mellitus (DM), body mass index (BMI), age, and sex. Among 3152 operated patients, 1675 patients were included in the study. The univariate analysis showed that male sex, high BMI, and long duration of operation were significant risk factors for colon surgery and that advanced age, presence of DM and long duration of operation were significant risk factors for gastric surgery. The multivariate analysis indicated that significant risk factors for SSI were BMI of 25 or above, open surgery, and long duration of operation for colon surgery and open surgery for gastric surgery. The SSI rate of laparoscopic colon surgery was 40%, less than that of open colon surgery, and that of laparoscopic gastric surgery was 75%, less than that of open gastric surgery. The risk factors for SSI depend on whether the operation is laparoscopic or open and duration of operation. In addition, BMI (25 or above) and age (70 years or above) are risk factors for colon and gastric surgery, respectively.

Risk factors for surgical site infection after surgery for esophageal perforation

Esophageal perforations carry a high potential for morbidity and mortality. The prognosis depends on rapid and precise diagnosis and management. Surgical site infections (SSIs) are very common following the surgical treatment of esophageal lesions. We aimed identify significant risk factors for SSI after surgery for esophageal perforation via an historical cohort study including patients who underwent surgical management of esophageal perforation. The predictive variables were analyzed by bivariate analysis and multiple logistic regression. Eighty-one patients were studied during a 10-year period ending in 2004. The mean age was 42.6 years. In 44% of the patients the time interval between the perforation and surgery was up to 6 h and in 30% it was > 24 h. Associated lesions occurred in other cavities; 17% in the chest, 5% in the abdomen, 5% in the extremities, 4% in the spinal column and bone marrow and 2% in the face. There were grade I lesions in eight cases (10%), grade II in 64 cases (79%) and grade III in nine cases (11%). The mean time of surgery procedure was 117.2 min. The mean SSI was 7.99. SSIs occurred in 33 patients (41%). The risk factors for SSI following surgical management of esophageal perforation were: age > or = 50 years, time delay to treatment > 24 h, associated lesion in another cavity and Injury Severity Score > or = 15.

Polyethylene glycol versus sodium phosphate mechanical bowel preparation in elective colorectal surgery

Background The type of mechanical bowel preparation (MBP) used before elective colorectal surgery remains controversial. Methods This post hoc analysis of a prospective randomized controlled antibiotic prophylaxis trial (ertapenem vs. cefotetan) evaluated the effect of polyethylene glycol (PEG) and sodium phosphate (SP) MBPs on the rates of postoperative surgical site infections (SSI). Results Good to excellent MBPs were observed in 281 of 303 (93%) evaluable patients for the PEG and 336 of 367 (92%) for the SP types. A higher rate of SSI was observed in the PEG (34%) than SP (24%) group (difference, 10%; 95% confidence interval, 3.4–17.2). The MBP type was a significant risk factor for SSI, with SP favored over PEG (odds ratio, .6; 95% confidence interval, .43–.85) in univariate analysis; multivariate analysis favored SP, but was not significant (odds ratio, .69; 95% confidence interval, .46–1.02). SSI was lowest with SP and ertapenem (19%) and highest with PEG and cefotetan (44%). Conclusions SP, coupled with ertapenem antibiotic prophylaxis, may improve outcomes and reduce SSIs in patients undergoing elective colorectal surgery when compared with PEG coupled with cefotetan antibiotic prophylaxis.

Reduction of surgical site infections after Caesarean delivery using surveillance

Since 1997, the Krankenhaus Infektions Surveillance System (KISS) has collected data on surgical site infections (SSIs) following Caesarean delivery (CD). The aim of this study was to determine whether surveillance and feedback of healthcare-associated infections (HAIs) could reduce the infection rate after CD. Only departments that had participated in KISS for at least three years were included in the analysis. The CD infection rates of the first, second and third years of KISS participation were compared for significant differences. The relative risk was calculated for the first and the third year of KISS participation. Multi-variate logistic regression analysis was performed to detect significant risk factors for SSI after CD using the third year of participation as one parameter. Twenty-six of 52 obstetric and gynaecology departments met the study's inclusion criteria. In those 26 departments, 17,405 CD procedures were performed and 331 SSIs were recorded (1.9%). The SSI rate after CD procedures was significantly reduced in the third year of KISS participation (1.6%) compared with the first year of KISS participation (2.4%), with a relative risk of 0.63 [95% confidence interval (CI) 0.48-0.82]. Logistic regression analysis confirmed that KISS participation over three years was an independent factor for the reduction of SSI rate (odds ratio 0.64; 95% CI 0.49-0.83). As shown previously for other types of HAI, this study demonstrated that continuous surveillance and comparison with stratified reference data could reduce SSI infection rates after CD.

Incidence of and risk factors for surgical site infection in patients with radical cystectomy with urinary diversion

In radical cystectomy (RC), surgical-site infection (SSI) remains one of the most frustrating postoperative complications. Only a few reports have assessed SSI after RC according to the guideline authorized by the Centers for Disease Control and Prevention (CDC guideline). In this study, using the guideline, we assessed the incidence, causative organisms, classification, and risk factors for SSI in patients receiving RC with urinary diversion (UD). The subjects of this study were 104 patients who underwent RC with UD at the Department of Urology, Sapporo Medical University Hospital, between January 1996 and December 2003. As prophylactic antimicrobial agents, intravenous cephalosporins or penicillins were started before surgery and maintained until postoperative day 3. Patients who had preoperative bacteriuria were treated with antimicrobial agents before operation to eradicate the bacteria or reduce their number. The CDC guideline was used for the diagnosis of SSI. The overall incidence of SSI was 33%. The most frequent type of SSI was superficial incisional infection (71%). Methicillin-resistant Staphylococcus aureus (MRSA) was the most frequently isolated organism, accounting for 38% of the causative organisms. Operation time was shown to be a significant risk factor for SSI. Preoperative antibacterial chemotherapy for bacteriuria was not sufficiently efficacious to decrease the incidence of SSI. In our study, the incidence of SSI after RC was 33%, although 71% of the infections were superficial. It is necessary to establish more appropriate countermeasures to prevent SSI after RC with UD; in particular, that caused by MRSA.

Surgical site infection surveillance after open gastrectomy and risk factors for surgical site infection

Surgical site infection (SSI) surveillance was examined in gastric cancer patients who had undergone an open gastrectomy between 1997 and 2003 at Keio University Hospital in Tokyo, Japan. National Nosocomial Infections Surveillance (NNIS) reports and several studies have discussed SSI risk factors, but only open gastrectomy was analyzed by regression analysis. The purpose of this study was to examine these issues by performing a regression analysis for the prediction of SSI. SSI was defined by the surgical patient component according to the NNIS system (1999) produced by the Centers for Disease Control and Prevention. Patients undergoing an open gastrectomy were followed up and monitored for SSIs. Risk factors for SSI, after all factors were considered, were studied using single and multivariate analysis. The study enrolled 984 patients who had undergoing an open gastrectomy. Using multivariate and logistic regression analysis, the duration of the operation was identified as a [corrected] risk factor for SSI at open gastrectomy. Although numerous potential risk factors in surgical patients were examined, the duration of the operation was the only significant risk factor for SSIs after open gastrectomy.

Surgical Site Infections: Reanalysis of Risk Factors

Background. Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. During 1986–1996 the Center for Disease Control and Prevention's National Nosocomial Infections Surveillance system reported 15,523 SSI following 593,344 operations (2.6%). Previous studies have documented patient characteristics associated with an increased risk of SSI, including diabetes, tobacco or steroid use, obesity, malnutrition, and perioperative blood transfusion. In this study we sought to reevaluate risk factors for SSI in a large cohort of noncardiac surgical patients.Methods. Prospective data (NSQIP) were collected on 5031 noncardiac surgical patients at the Veteran's Administration Maryland Healthcare System from 1995 to 2000. All preoperative risk factors were evaluated as independent predictors of surgical site infection.Results. The mean age of the study cohort was 61 ± 13. SSI occurred in 162 patients, comprising 3.2% of the study cohort. Gram-positive organisms were the most common bacterial etiology. Multiple logistic regression analysis documented that diabetes (insulin- and non-insulin-dependent), low postoperative hematocrit, weight loss (within 6 months), and ascites were significantly associated with increased SSI. Tobacco use, steroid use, and chronic obstructive pulmonary disease (COPD) were not predictors for SSI.Conclusion. This study confirms that diabetes and malnutrion (defined as significant weight loss 6 months prior to surgery) are significant preoperative risk factors for SSI. Postoperative anemia is a significant risk factor for SSI. In contrast to prior analyses, this study has documented that tobacco use, steroid use, and COPD are not independent predictors of SSI. Future SSI studies should target early preoperative intervention and optimization of patients with diabetes and malnutrition.

The Effect of Traffic Patterns in the OR on Surgical Site Infections

Perioperative nurses are situated uniquely to promote good traffic control practices in the OR. This study was conducted to explore the effect of traffic patterns, specifically the number of people in the OR, on the incidence of surgical site infections (SSIs). Researchers analyzed 2,864 clean surgical procedures performed in 1995 in an academic medical center. Duration of surgery and American Society of Anesthesiologists' physical assessment score were statistically significant risk factors for SSIs. A rising trend in SSIs was observed as the number of people in the OR increased; however, it was not statistically significant. Risk factors for SSIs must be better understood to develop more effective prevention programs.

Alcohol abuse: A risk factor for surgical wound infections?

Background: The incidence of postoperative surgical site infections (SSIs) is difficult to estimate because of the current trend of early discharge after surgery. Both operation-related and host factors should be taken into consideration in the prevention of SSIs. We wanted to determine the actual incidence of SSIs and evaluate the risk factors in our clinic, using an extended follow-up period of 30 days after operations. Methods: We performed a prospective follow-up survey of SSIs over a 3.5-month period including a 1-month follow-up after discharge with written instructions and a telephone survey. The SSIs were defined according to Centers for Disease Control and Prevention criteria. Forty-three patient parameters were recorded, and risk factors for SSI were sought and tested by using multiple logistic regression analysis. Results: The follow-up was completed in 772 of 807 patients. The SSI rates in these patients were 5.3% in clean, 7.1% in clean-contaminated, 6.2% in contaminated, and 28.1% in dirty operations. Seventy-one percent of infections were not diagnosed until after discharge from the hospital. According to multiple logistic regression analysis, alcohol abuse ( p < 0.0001), wound contamination class ( p < 0.05), and operation duration of over 2 hours ( p < 0.05) were independently significant risk factors for SSI. Conclusions: A major portion of SSIs are found only after follow-up is extended during the postdischarge period. Alcohol abuse is a significant risk factor for SSI and should be taken into account when determining the susceptibility of an individual patient.