Pre-Operative Risk Factors Contributing to Develop Surgical Site Infection After Elective and Emergent Colorectal Surgery

Abstract

Introduction: Surgical site infection (SSI) has been associated with increased hospital stay and subsequent increased burden on health care. Recognition of risk factors might be helpful to prevent it.Materials & Methods: Patients referring to colorectal department of Imam Khomeini Hospital Complex for elective or emergent surgery have been evaluated during January 2018 and 2019. All the variables known to be associated with SSI have been investigated.Results: Total number of 473 patients with mean ± SD of age, 55.6 ± 13.9 years (range 18-88 years) and male to female ratio of 1.4 were evaluated. 103 patients developed SSI within 30 days after surgery with the incidence rate of 21.7%. Seventy seven percent of patients with SSI were in the age group under 65 years, 42% were female, and 58% were male. There were 89 cases of superficial (86%), 11 cases of deep (10%), and 3 cases of organ/space surgical site infection (3%).The risk factors significantly associated with SSI development were diabetes mellitus, operation on rectum, emergency surgery, history of neoadjuvant chemotherapy, laparoscopy approach changed to laparotomy approach, colostomy /ileostomy implantation or closure, blood transfusion after surgery, anastomotic leakage, and surgery lasting more than 200 minutes. After multivariate analysis, neo-adjuvant chemo-radiotherapy, emergent surgery, operation on rectum, postoperative blood transfusion, and prolonged operation to discharge periods remained significantly associated with a remarkably higher SSI risk. Conclusion: SSI is devastating condition, compromising surgical outcomes. Preventive measures should be applied in every surgical facilities to prevent incidence and lessen complications related to SSI.

Keywords

• surgical site infection
• colorectal surgery
• risk factor
• chemo-radiation
• hospital stay