Abstract
Background
Surgical site infection (SSI) is the third most common hospital-acquired infection (HAI). Specific patient characteristics and comorbidities appear to be independent prognostic factors for SSIs. In addition, operation and hospitalization characteristics affect the incidence of SSIs.
Methods
This prospective clinical study was conducted in the 1st Department of Surgery of the Sismanoglion General Hospital of Athens over a period of 7 years. Patients undergoing elective abdominal surgery received antimicrobial treatment as chemoprophylaxis. Monitoring of the patients was carried by multiple daily visits during their hospitalization and continued after they were discharged via phone until postoperative day 30.
Results
During the study period, 31 of the 715 patients undergoing elective abdominal surgery were diagnosed with SSI, giving an infection rate of 4.3%. The age of the patients with SSIs was significantly higher. Patients with certain comorbidities, including diabetes mellitus (DM), respiratory deficiency and heart failure (HF), a severity score on the American Society of Anesthesiologists (ASA) physical status classification system of ASA>3, and those with concomitant infections had a significantly increased risk of SSIs. SSIs were more common following open surgery than laparoscopic surgery, and surgery of the lower than the upper gastrointestinal (GI) tract, and postoperative hemorrhage increased the risk.
Conclusion
There is a paucity of studies assessing the relative contribution of the various predisposing factors to the incidence of SSIs. In our study, patients with DM, HF, respiratory deficiency, postoperative hemorrhage and concomitant infections, and patients undergoing lower GI tract operation appeared more prone to SSIs, presenting this complication 2 to 8 times more frequently. The risk of SSI following laparoscopic surgery was one quarter of that of open elective abdominal surgery. On the other hand, patients in this series with obesity, renal failure, steroid intake, radiation therapy, thyroid disease, stomas, previous surgery, intraperitoneal adhesions and inflammatory bowel disease did not develop SSIs more frequently.
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References
Swenne CL, Lindholm C, Borowiec J, et al. Peri-operative glucose control and development of surgical wound infections in patients undergoing coronary artery bypass graft. J Hosp Infect 2005;61:201–12.
Latham R, Lancaster AD, Covington JF, et al. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol 2001;22:607–12.
Van Den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345:1359–67.
Ambiru S, Kato A, Kimura F, et al. Poor postoperative blood glucose control increases surgical site infections after surgery for hepato-biliary-pancreatic cancer: A prospective study in a high-volume institute in Japan. J Hosp Infect 2008; 68:230–3.
Brown IW Jr, Moor GF, Hummel BW, et al. Toward further reducing wound infections in cardiac operations. Ann Thorac Surg 1996;62:1783–9.
Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Haley RW, Culver DH, Morgan WM, et al. Am J Epidemiol 1985;121:206–15.
Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91(Suppl 3B):152S–7S.
Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428–42.
Broex EC, van Asselt AD, Bruggeman CA, et al. Surgical site infections: How high are the costs? J Hosp Infect 2009; 72:193–201.
Fry DE. Surgical site infections and the surgical care improvement project (SCIP): Evolution of national quality measures. Surg Infect 2008;9:579–84.
Urban JA. Cost analysis of surgical site infection. Surg Infect 2006;7(Suppl 1):S19–S22.
Vegas AA, Jodra VM, Garcia ML. Nosocomial infection in surgery wards: A controlled study of increased duration of hospital stays and directs cost of hospitalization. Eur J Epidemiol 1993;9:504–10.
Smith RL, Bohl JK, McElearney ST, et al. Wound infection after elective colorectal resection. Ann Surg 2004;239:599–607.
De Lissovoy G, Fraeman K, Hutchins V, et al. Surgical site infection: Incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387–97.
Calia FM, Wolinsky E, Mortimer EA Jr., et al. J Hyg. Importance of the carrier state as a source of Staphylococcus aureus in wound sepsis. (Lond) 1969;67:49–57.
Dineen P, Drusin L. Epidemics of postoperative wound infections associated with hair carriers. Lancet 1973;2(7839):1157–9.
Perl TM, Cullen JJ, Pfaller MA, et al. A randomized, doubleblind, placebo-controlled clinical trial of intranasal mupirocin ointment (IM) for prevention of S. aureus surgical site infections (SSI). Abstracts of the IDSA 36th Annual Meeting 1998;91.
Barber GR, Miransky J, Brown AE, et al. Direct observations of surgical wound infections at a comprehensive cancer center. Arch Surg 1995;130:1042–7.
Vamvakas EC, Carven JH. Transfusion of white-cell-containing allogeneic blood components and postoperative wound infection: Effect of confounding factors. Transfus Med 1998;8:29–36.
Ambiru S, Kato A, Kimura F, et al. Poor postoperative blood glucose control increases surgical site infections after surgery for hepato-biliary-pancreatic cancer: A prospective study in a high-volume institute in Japan. J Hosp Infect 2008;68:230–3.
Thomsen T, Tønnesen H, Møller AM. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. Br J Surg 2009;96:451–61.
Sorensen LT, Kalsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: A randomized controlled trial. Ann Surg 2003;238:1–5.
Winfield RD, Reese S, Bochicchio K, et al. Obesity and the risk for surgical site infection in abdominal surgery. Am Surg 2016;82:331–6.
Stanic S, Bojanic J, Grubor P, et al. Examination of risk factors for the development of surgical site infections. Mater Sociomed. 2017;29:134–7.
Gibbons C, Bruce J, Carpenter J, et al. Identification of risk factors by systematic review and development of riskadjusted models for surgical site infection. Health Technol Assess 2011;15
Hranjec T, Swenson BR, Sawyer GR. Surgical Site Infection Prevention: How We Do It. Surg Infect (Larchmt). 2010;11:289–294.
Jon Stuart Hourigan. Impact of Obesity on Surgical Site Infection in Colon and Rectal Surgery. Clin Colon Rectal Surg. 2011;24:283–90.
Wick EC, Hirose K, Shore AD, et al. Surgical site infections and cost in obese patients undergoing colorectal surgery. Arch Surg. 2011;146:1068–72.
Aimaq R, Akopian G, Kaufman HS. Surgical site infection rates in laparoscopic versus open colorectal surgery. Am Surg. 2011;77:1290–4.
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Alexiou, K., Terzopoulou, M., Sikalias, N. et al. Surgical Site Infections in Elective Abdominal Operations: Predisposing Factors. A Prospective Randomized Clinical Trial. Hellenic J Surg 90, 69–74 (2018). https://doi.org/10.1007/s13126-018-0443-5
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DOI: https://doi.org/10.1007/s13126-018-0443-5