Risk Factors Analysis for Surgical Site Infection Following Elective Colorectal Resection

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Risk Factors Analysis for Surgical Site Infection Following Elective Colorectal Resection: A Retrospective Regression Analysis

Authors: Pu-Run Lei, Jing-Wen Liao, Ying Ruan, Xiao-Feng Yang, Kun-Peng Hu, Jian-Pei Liu, Tu-Feng Chen

Affiliations: Departments of Gastrointestinal Surgery, Bone Surgery, Thyroid and Breast Surgery, and General Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

Published in: Chinese Medical Journal 2020;133(5)

DOI: 10.1097/CM9.0000000000000670

Introduction

Surgical site infection (SSI) is a significant concern in elective colorectal surgery. It can lead to longer hospital stays, higher costs, and increased mortality. Understanding the risk factors for SSI is crucial for developing preventive strategies. This study aimed to analyze the factors associated with the incidence of all types of SSI in patients undergoing elective colorectal resection.

Methods

Patient Selection

A retrospective search was conducted using the patient database of the Gastrointestinal Surgery Center of The Third Affiliated Hospital of Sun Yat-sen University from January 2011 to August 2017. Only patients who underwent elective laparoscopic or laparotomic colorectal resection due to malignancy were included. Each SSI was sub-classified as superficial incisional SSI (SSSI), deep incisional SSI (DSSI), and/or organ space infection (OSI).

Data Extraction

Pre-operative demographic and surgical data were extracted, including age, sex, smoking status, body mass index (BMI), comorbidities (American Society of Anesthesiologists [ASA] score), surgical approach, tumor and resection region, pre-operative bowel preparation modes (oral antibiotics plus mechanical bowel preparation [MBP] or MBP alone), pre-operative levels of serum albumin and hemoglobin, pre-operative diagnosis of diabetes, surgical duration, post-operative intravenous antibiotic use and duration, and pathological tumor stage (7th American Joint Committee on Cancer Tumor Node Metastasis [TNM] staging).

Statistical Analysis

Univariate and multivariate logistic regression analyses were performed to identify factors affecting the incidence of SSI. Propensity score matching was used to minimize confounding factors and explore the prophylactic effect of pre-operative administration of oral antibiotics.

Results

Patient Characteristics

A total of 581 patients were enrolled in the data analysis. SSIs developed in 57 patients (9.81%). The overall mean post-operative length of stay (LOS) in the SSI group was significantly longer (16.1 ± 9.3 days) than in the no SSI group (8.9 ± 3.8 days). The total hospitalization expense was also higher in the SSI group.

Univariate Analysis

  • Protective factors: Younger age (<65 years) (odds ratio [OR]: 0.378; 95% confidence interval [CI]: 0.218–0.657) and pre-operative oral antibiotic use (OR: 0.465; 95% CI: 0.255–0.850).
  • Risk factors: Pre-operative anemia (OR: 4.591; 95% CI: 2.567–8.211), neoadjuvant chemotherapy history (OR: 2.398; 95% CI: 1.094–5.256), and longer surgical duration (>4 h) (OR: 2.393; 95% CI: 1.349–4.246; P = 0.002).

Multivariate Analysis

  • Independent factors: Age (P = 0.003), surgical duration (P = 0.001), and pre-operative oral antibiotic use (P < 0.001).

Propensity-Matched Analysis

Confirmed the protective effect of oral antibiotic use. A 1-day course of oral antibiotic produced a similar effect to a 3-day course.

Discussion

Risk Factors

  • Age: Older patients are more likely to have comorbidities and reduced immunity, increasing the risk of SSI.
  • Surgical Duration: Longer surgeries may involve more tissue manipulation and exposure to bacteria, increasing the risk of infection.
  • Pre-operative Anemia: May indicate underlying health problems or nutritional deficiencies, affecting the body’s ability to fight infection.
  • Neoadjuvant Chemotherapy: Can suppress the immune system, increasing the risk of SSI.

Protective Factors

  • Pre-operative Oral Antibiotic Use: Combined with MBP, it can reduce the bacterial load in the colon, decreasing the risk of SSI.

Dosage Analysis

A 1-day course of oral antibiotics was found to be as effective as a 3-day course in reducing the incidence of SSI. This is important as a shorter course may reduce the risk of antibiotic-related side effects and costs.

Conclusion

Age, surgical duration, and pre-operative oral antibiotic use were associated with the incidence of SSI. However, pre-operative oral antibiotic use was the only controllable factor. From the results of this study, pre-operative oral antibiotic use is recommended before elective colorectal surgery, and a 1-day course is enough to provide the protective effect.

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