S. R. Durbin1, J. Peschman2, D. Milia2, T. Carver2, C. Dodgion2 1Medical College Of Wisconsin,Milwaukee, WI, USA 2Medical College Of Wisconsin,Department Of Surgery,Milwaukee, WI, USA
Introduction:
Surgical site infections (SSIs) have a substantial impact on economic and health indices for patients and healthcare institutions. The aim of this study was to identify risk factors for superficial surgical site infections in operative abdominal trauma patients using a national cohort.
Methods:
A retrospective analysis of all adult trauma patients treated within the Trauma Quality Improvement Database (TQIP) who underwent an abdominal operation from 2010-2015 was performed. Risk factors for infection were evaluated using χ2, Wilcoxon rank sum, and multivariate logistic regression.
Results:
There were 46,611 patients who underwent an exploratory laparotomy for trauma. The median age was 33 [24-50]; 36,337 (77.7%) were male and 24,968 (55.5%) were Caucasian. There were 20,750 (44.8%) penetrating injuries and the median injury severity score (ISS) was 21 [13-30]. 12,407 (26.5%) suffered a hollow viscus injury with one (9,457;20.2%), two (2,618;5.6%) or > three (354;0.7%) organs injured respectively. Overall, 1,944 (4.2%) patients developed an SSI, with >15% of all colon and duodenal injuries developing an infection. On multivariate analysis, after controlling for gender, type of injury, shock on arrival, smoking status, diabetes, and steroid use or chemotherapy use, colonic injuries conferred the greatest independent risk for superficial SSIs (OR 2.91 [2.44-3.48]) followed by duodenal injuries (OR 1.92 [1.21-3.06]) small bowel injuries (OR 1.56 [1.30-1.87]) gastric injuries (OR 1.43 [1.07-1.91]), BMI >30 (1.33 [1.15-1.55]), African American race (OR 1.22 [1.03-1.47]), increasing ISS (OR 1.01 [1.01-1.02] and increasing age (OR 1.01 [1.002-1.01]. Additionally, an increasing number of hollow viscus injuries was associated with a greater risk for superficial SSI; one (OR 2.75 [2.32-3.26]), two (OR 3.81 [2.98-4.89]) or three (OR 6.85 [4.20-11.17]) organs injured respectively.
Conclusion:
The incidence of superficial SSI in operative abdominal trauma patients increases with higher ISS, increased BMI, increased age and an increasing number hollow viscus injuries. Colon and duodenal injuries, in particular, impart the greatest risk. Consideration should be given to avoiding primary skin closure in patients with these risk factors as a way to mitigate SSIs in this patient population.