Y. Xiao1, D. Calixte3, L.A. Benedict1,4, W. Brigode2 1University of Missouri, Kansas City, Surgery, Kansas City, MI, USA 2John H. Stroger Jr. Hospital of Cook County, Department Of Trauma And Burn, Chicago, IL, USA 3St George’s University School of Medicine, Chicago, IL, USA 4Saint Luke’s Hospital of Kansas City, Kansas City, MI, USA
Introduction:
Superficial surgical site infection (SSI) and deep organ space infection (DOSI) are
among the most prevalent post-operative complications following emergent or elective bowel
resection and anastomosis. The aim of this study was to examine whether specific anatomical
sites are associated with higher infection rates in patients undergoing colectomy with primary
anastomosis.
Methods:
National Surgical Quality Improvement Program (NSQIP) database retrospective
cohort study including patients who underwent open colectomy with primary anastomosis. The
incidence, outcome and risk factors for superficial SSI and DOSI were evaluated using univariate
and multivariate analysis.
Results:
A total of 101,584 patients underwent colonic resection with ileocolic (CPT44160),
colocolic (CPT44140), or colorectal (CPT44145) anastomosis formed the population for this
study. 34,139 (33.6%) underwent ileocolostomy, 44,717 (44.0%) patients had a colocolstomy,
and 22,728 (22.4%) had a coloproctostomy. Our univariate analysis examined the overall
superficial SSI and DOSI infection rate of each anatomic location (Table 1). The data
consistently indicated that an ileocolostomy was associated with higher rate for superficial SSI
(OR: 1.11, IC: 1.05-1.18) and DOSI (OR: 1.19, IC: 1.14-1.25). However, the multivariate
analysis indicated that emergency operation, diabetes, current smoker, systemic sepsis and
disseminated cancer are the risk factors for superficial SSI and DOSI, but not the type of surgical
resection and anastomosis.
Conclusion:
Patients undergoing emergency bowel resection with primary ileocolonic
anastomosis have higher mortality, risk of post-op infection, and systemic complications.
Independent predictors of SSI and DOSI include emergency operations, systemic sepsis or septic
shock on admission, diabetes, current smoker and disseminated cancer. The rate of superficial
SSI and DOSI were not found to be significantly associated with anastomotic location.