Incisional surgical site infection after elective open surgery for colorectal cancer

Bowel Resection Outcomes in Ovarian Cancer Cytoreductive Surgery by Surgeon Specialty

Importance

Extensive bowel surgery is often necessary to achieve complete cytoreduction in patients with epithelial ovarian cancer. Regardless of who performs the surgery, it has been well documented that bowel resections are a high-risk procedure and an anastomotic leak is a severe complication that can occur. There are few studies addressing whether surgeon type impacts surgical outcomes in this patient population.

Objective

To compare surgical outcomes between gynecologic oncologist, general surgeons, and a 2-surgeon team approach for patients with advanced epithelial ovarian cancer who underwent bowel surgery during cytoreductive debulking.

Design, Setting, Participants

This retrospective cohort study used the American College of Surgeons' National Surgical Quality Improvement Program datasets from 2012 through 2020. The aforementioned years of the dataset were analyzed from March 2022 to March 2023 and reanalyzed in May 2024 for quality assurance. Analysis of cytoreductive surgeries performed by a gynecologic oncologist, a general surgeon, or a 2-surgeon team approach for patients with ovarian cancer recorded in National Surgical Quality Improvement Program datasets was included. The 2-surgeon team approach included any combination of the aforementioned surgical specialties.

Main outcome and measure

The primary outcome of interest was anastomotic leak after bowel surgery during ovarian cancer debulking.

Results

A total of 1810 patients were included in the study; in the general surgery cohort, mean (SD) patient age was 65.1 (11.1) years and mean (SD) body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) was 26.9 (7.4); in the gynecologic oncology cohort, mean (SD) patient age was 63.5 (11.7) years and mean BMI (SD) was 27.7 (6.5); and in the 2-surgeon team cohort, mean (SD) patient age 62.4 (12.1) years and mean (SD) BMI was 28.1 (7.0). Gynecologic oncologists performed 1217 cases (67.2%), general surgery performed 97 cases (5.4%), and 496 cases had 2-surgeon teams involved (27.4%). Bivariate analysis revealed an anastomotic leak rate of 3.6% for gynecologic oncologists, 5.2% for general surgeons, and 0.4% for cases that had 2 surgical teams involved (P < .001). By multivariable analysis, the adjusted odds ratio for anastomotic leak was 1.53 (95% CI, 0.59-3.96) for the general surgeon group (P = .38) vs an adjusted odds ratio of 0.11 (95% CI, 0.03-0.47) for the 2-surgeon team approach (P = .003) with the referent being gynecologic oncology.

Conclusion and Relevance

In this study, the anastomotic leak rate was found to be lower when 2 surgeons participated in the case, regardless of the surgical specialty. These results suggest that team-based care improves surgical outcomes.

Impact of Intra-Operative Shock and Resuscitation on Surgical Site Infections After Trauma Laparotomy

Background: Patients undergoing trauma laparotomy experience high rates of surgical site infection (SSI). Although intra-operative shock is a likely contributor to SSI risk, little is known about the relation between shock, intra-operative restoration of physiologic normalcy, and SSI development. Patients and Methods: A retrospective review of trauma patients who underwent emergent definitive laparotomy was performed. Using shock index and base excess at the beginning and end of laparotomy, patients were classified as normal, persistent shock, resuscitated, or new shock. Univariable and multivariable analyses were performed to identify predictors of organ/space SSI, superficial/deep SSI, and any SSI. Results: Of 1,191 included patients, 600 (50%) were categorized as no shock, 248 (21%) as resuscitated, 109 (9%) as new shock, and 236 (20%) as persistent shock, with incidence of any SSI as 51 (9%), 28 (11%), 26 (24%), and 32 (14%), respectively. These rates were similar in organ/space and superficial/deep SSIs. On multivariable analysis, resuscitated, new shock, and persistent shock were associated with increased odds of organ/space SSI (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.3-3.5; p < 0.001) and any SSI (OR, 2.0; 95% CI, 1.4-3.2; p < 0.001), but no increased risk of superficial/deep SSI (OR, 1.4; 95% CI, 0.8-2.6; p = 0.331). Conclusions: Although the trajectory of physiologic status influenced SSI, the presence of shock at any time during trauma laparotomy, regardless of restoration of physiologic normalcy, was associated with increased odds of SSI. Further investigation is warranted to determine the relation between peri-operative shock and SSI in trauma patients.

A meta-analysis of the risk factors for surgical site infection in patients with colorectal cancer

The purpose of the meta-analysis was to evaluate and compare the surgical site infection (SSI) risk factors in patients with colorectal cancer (CC). The results of this meta-analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random or fixed-effect models. For the current meta-analysis, 23 examinations spanning from 2001 to 2023 were included, encompassing 89 859 cases of CC. Clean-contaminated surgical site wounds had significantly lower infections (OR, 0.36; 95% CI, 0.20-0.64, p < 0.001) compared to contaminated surgical site wounds in patients with CCs. Males had significantly higher SSIs (OR, 1.18; 95% CI, 1.12-1.24, p < 0.001) compared to females in patients with CC. American Society of Anesthesiology score ≥3 h had a significantly higher SSI (OR, 1.42; 95% CI, 1.18-1.71, p < 0.001) compared to <3 score in patients with CCs. Body mass index ≥25 had significantly higher SSIs (OR, 1.54; 95% CI, 1.11-2.14, p = 0.01) compared to <25 in patients with CCs. The presence of stoma creation had a significantly higher SSI rate (OR, 2.28; 95% CI, 1.37-3.79, p = 0.001) compared to its absence in patients with CC. Laparoscopic surgery had significantly lower SSIs (OR, 0.68; 95% CI, 0.59-0.78, p < 0.001) compared to open surgery in patients with CC. The presence of diabetes mellitus had a significantly higher SSI rate (OR, 1.24; 95% CI, 1.15-1.33, p < 0.001) compared to its absence in patients with CCs. No significant difference was found in SSI rate in patients with CCs between <3 and ≥3 h of operative time (OR, 1.07; 95% CI, 0.75-1.51, p = 0.72), between the presence and absence of blood transfusion (OR, 1.60; 95% CI, 0.69-3.66, p = 0.27) and between the presence and absence of previous laparotomies (OR, 1.47; 95% CI, 0.93-2.32, p = 0.10). The examined data revealed that contaminated wounds, male sex, an American Society of Anesthesiology score ≥3 h, a body mass index ≥25, stoma creation, open surgery and diabetes mellitus are all risk factors for SSIs in patients with CC. However, operative time, blood transfusion and previous laparotomies were not found to be risk factors for SSIs in patients with CC. However, given that several comparisons had a small number of chosen research, consideration should be given to their values.

Infections and Colon Surgery: Preliminary Results from a Surveillance Program in an Italian Hospital

Surgical site infections (SSIs) represent a valid indicator of the healthcare quality. This study described the preliminary results of one-year active surveillance program on colon surgeries in a hospital in Molise region, central Italy. Patients who had undergone colon surgery according to National Healthcare Safety Network were included. Data on intervention, perioperative antibiotic prophylaxis, and SSIs occurrence were collected. Chi-square and Fisher's Exact test were used to evaluate any association between risk factors and SSIs. Sixty-eight patients (mean age 70.6 years) were included, and 44 (64.7%) were males. The most frequent interventions were right (n = 17, 25.0%) and left (n = 15, 22.0%) hemicolectomy. Surgical interventions were largely elective (n = 43, 63.2%) and with laparotomy (n = 56, 82.4%). During hospital stay, 10 (14.7%) SSIs were detected, including five superficial, three deep and two organ/space infections. Three (4.4%) additional SSIs were detected at post-discharge follow-up, for 13 (19.1%; CI95%: 9.7%-28.5%) total cases detected. Metronidazole plus Ceftriaxone (third generation cephalosporin) was the antibiotics combination mostly used (n = 36, 52.9%) for the perioperative antibiotic prophylaxis within 60 minutes of incision. The study underlines the need of improvements of the practices currently adopted, since SSIs could be significantly reduced through a multimodal strategy generating bundles. As third generation cephalosporins may facilitate resistant strains emergence, for perioperative prophylaxis in clean-contaminated interventions with entry into gastrointestinal tract, Cefazolin plus Metronidazole or only second generation cephalosporin are recommended. Due to the large variability of post-intervention antibiotic therapy, antimicrobial stewardship approach is strictly necessary.

Perioperative Use of Glucocorticoids and Intraoperative Hypotension May Affect the Incidence of Postoperative Infection in Patients with Gastric Cancer: A Retrospective Cohort Study

Background

In patients undergoing surgical resection for gastric cancer, postoperative complications—in particular, postoperative infections—remain an important problem and can result in delayed recovery and increased postoperative mortality.

Objective

To investigate the association between perioperative anesthesia management and postoperative infectious complications in patients undergoing resection for gastric cancer.

Design

Retrospective cohort study.

Setting

A single-center study performed from April 1, 2015, to June 30, 2018, at Peking University Cancer Hospital.

Patients

Patients who underwent resection for gastric cancer.

Main Outcome Measures

Demographic information, perioperative data (including anesthesia-related data, surgery-related data, and cancer diagnosis), and information on postoperative recovery were recorded. The primary outcome was incidence of postoperative infection; the secondary outcome was length of hospital stay. The associations between perioperative factors and postoperative infectious complications were analyzed using multivariable logistic regression models and the classification tree method.

Results

A total of 880 patients were included in the study; of these, 111 (12.6%) had postoperative infectious complications during hospitalization, including 78 surgical site infections and 62 remote infections. After correction for confounding factors on logistic multivariable analysis, perioperative use of glucocorticoids was associated with a lower incidence of postoperative infection (hazard ratio 0.968, 95% confidence interval 0.939 to 0.997, P=0.029), and intraoperative systolic blood pressure <90 mmHg for >10 min was associated with a higher incidence of postoperative infection (hazard ratio 2.112, 95% confidence interval 1.174 to 3.801, P=0.013). In addition, older age, preoperative hypoproteinemia, and total gastrectomy were identified as independent predictors of postoperative infection.

Conclusion

For patients with gastric cancer, perioperative use of glucocorticoids and avoiding intraoperative hypotension may decrease the incidence of postoperative infectious complications.

Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection

Background  Surgical site infections (SSIs) are the infections of wound after an invasive operative approach. It remains to be a major morbidity for patients undergoing surgeries although there have been tremendous improvements in the surgical techniques.

Different interventions to suppress the selective serotonin reuptake inhibitors have been proposed. Many of them have been routinely used by surgeons like minimizing shaving, hand washing, and preoperative antibiotics and these are well accepted. Drains are used in major abdominal surgeries, hernia repairs, breast surgeries reducing collections in closed areas. 1 Hematoma, serous fluid, and dead space in surgical incision wounds raise the risk of infection as they serve as the platform for microbial growth. Studies have proved that the usage of subcutaneous drains has lowered the chances of infection.

Results  The patients in the case group had lower incidence of SSI compared with the control group. The patients in the case group had subcutaneous drain which drained any collection that developed in the subcutaneous space. When the incidence of SSI was compared between the emergency cases and elective cases, the emergency cases showed higher propensity for SSI and increased rate for patients who had co-morbidities like diabetes mellitus, hypertension, etc. The most common organism isolated from the SSI was found to be Escherichia coli . It was also noted that the mean number of days of hospital stay was comparatively higher for the patients who developed SSI compared with patients who did not develop SSI.

Conclusion  Thus the presence of SSI adds morbidity to the patient and the patients who undergo major surgeries are likely to develop SSI postoperatively. The presence of subcutaneous closed suction drain helps in reducing the SSI to a certain extent.

Impact of BMI on Adverse Events After Laparoscopic and Open Surgery for Rectal Cancer

PURPOSE

The impact of body mass index (BMI) on outcomes after open or laparoscopic surgery for rectal cancer remains unclear. The objective of this retrospective cohort study was to examine the interaction of body mass index and surgical modality (i.e., laparoscopy versus open) with respect to short-term clinical outcomes in patients with rectal cancer.

METHODS

The ACS-NSQIP database (2012-2016) was reviewed for patients undergoing open or laparoscopic surgery for rectal cancer. The primary outcome was 30-day all-cause morbidity. Logistic regression and Cox proportional hazard models were used for analysis.

RESULTS

A total of 16,145 patients were grouped into open (N = 6759, 42%) and laparoscopic (N  = 9386, 58%) cohorts. Patients with higher BMI (p < 0.001) and those undergoing open surgery (p < 0.001) were at increased risk of all-cause morbidity. There was no significant change in the odds ratio of experiencing all-cause morbidity between open and laparoscopic surgery with increasing BMI (p = 0.572). Median length of stay was significantly shorter in the laparoscopy group (4 days vs. 6 days; p < 0.001), at the cost of increased operative time (239 min vs. 210 min, p < 0.001). The difference in operative time between laparoscopy and open surgery did not increase with rising BMI (i.e., ∆37 min vs. ∆39 min at BMI 25 kg/m² vs 50 kg/m², respectively, p = 0.491).

CONCLUSION

BMI may not be a strong modifier for surgical approach with respect to short-term clinical outcomes in patients with obesity and rectal cancer. Laparoscopic surgery was associated with improved short-term clinical outcomes, without much change in the absolute difference in operative time compared with open surgery, even at higher BMIs.

Real-World Outcomes of Patients Undergoing Open Colorectal Surgery with Wound Closure Incorporating Triclosan-Coated Barbed Sutures: A Multi-Institution, Retrospective Database Study

Purpose

Open colorectal surgery is associated with a high rate of postoperative wound complications. This is a single-arm study of real-world outcomes of triclosan-coated barbed suture (Ethicon's STRATAFIX^TM Symmetric PDS^TM Plus Knotless Tissue Control Device [SSPP]) used in open colorectal surgery.

Methods

Retrospective cohort study using the Premier Healthcare Database. The study included patients who underwent an inpatient open colorectal surgery with wound closure using SSPP (size 0 or 1 to increase the likelihood the suture was used in fascia) between October 2015-September 2019 (N=593). Wound complications, hospital length of stay, total hospital costs (2019 US$), and all-cause readmissions post-discharge were measured. Post-hoc multivariable analyses compared wound complications between non-elective admissions and elective.

Results

The overall incidence of wound complications within 30-days post-procedure was 7.1%, with the majority of those being surgical site infections (SSI) (6.0%). Mean operation time was 190 (standard deviation [SD]=64.4) mins, postoperative length of stay was 8.1 (SD=11.9) days, 30-day readmission rate was 11.8%, and total hospital costs were $31,693 (SD=$40,076). As compared with published literature on the rate of SSI in colorectal surgery, the 30-day rate of SSI in the present study (6.0%) fell within the range of 5.4% to 18.2% for open colorectal surgery and from 4.3% to 21.5% for combined open and minimally invasive procedures. Multivariable-adjusted incidence proportions of wound complications were slightly lower for non-elective admissions and did not differ significantly from those of elective admissions.

Conclusion

The rate of wound complications observed in the present study falls within the range of rates previously reported in the literature, suggesting a safe and effective role for SSPP in open colorectal surgery. In post hoc analyses, the adjusted rate of wound complications was similar between non-elective and elective admissions. Head-to-head studies are required to determine comparative advantages or disadvantages for SSPP versus other sutures.

Incidence and root causes of surgical site infections after gastrointestinal surgery at a public teaching hospital in Sudan

Background

Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays, additional financial burden, and significantly hamper the potential benefits of surgical interventions. Causes of SSIs are multi-factorials and patients undergoing gastrointestinal tract procedures carry a high risk of bacterial contamination. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries.

Methods

A hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between 1st September and 31st December 2017. We collected data about the socio-demographic characteristics, risk factors of SSI, and isolated microorganisms from patients with SSIs. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05.

Results

A total of 80 participants were included in the study. The mean age was 51 +/- 16 years and most of the patients (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) of them underwent large bowel surgery. Twenty-two patients (27.5%) developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated from SSI patients was E coli (47.8%), followed by Enterococcus fecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%).

Conclusions

The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

[The role of neutrophil CD64 index in the diagnosis of infectious complications after colorectal resection]

OBJECTIVE

To determine diagnostic value of neutrophil CD64 index (iCD64n) in the diagnosis of postoperative infectious complications after colorectal resections.

MATERIAL AND METHODS

Seventy-three patients underwent colorectal surgery for the period from January to December 2018. These patients were included into a single-center study. Peripheral blood samples were taken on 3 and 6 postoperative days (POD) to check iCD64n level. We analyzed incidence of postoperative infectious complications, sensitivity (Se) and specificity (Sp) of postoperative iCD64n level on the 3^rd and 6^th POD.

RESULTS

Postoperative infectious complications developed in 10 (13.7%) patients. Median iCD64n was significantly higher (p=0.0017 for POD 3; p=0.018 for POD 6) in patients with infectious complications (1.6 on POD 3; 1.3 on POD 6) compared to those without complications (1.1 on POD 3; 0.9 on POD 6). Area under curve (AUC) on the 3^rd POD was 0.8 with the cut-off value of 1.4, Se - 70%, Sp - 93.7% (p=0.002). On the 6^th POD, AUC was 0.91 with cut-off value of 1.23, Se - 80%, Sp - 93.7% (p<0.001).

CONCLUSION

Neutrophil CD64 index is a valuable predictor for the diagnosis of postoperative infectious complications after colorectal resections. It is a useful tool to ensure a safe early discharge.

The study is registered on the website «clinictrials.gov» (registration number NCT03559335).

Surgical site infection after digestive surgery in a single tertiary hospital in Indonesia: six years of data

BACKGROUND Surgical site infection (SSI) is responsible for increasing cost, morbidity, and mortality related to surgical operations, and has continued to be a significant problem even in hospitals with advanced facilities. This study aimed to describe the SSI among patients after digestive surgery. METHODS From 2012 to 2017, all abdominal surgeries with SSI in Cipto Mangunkusumo Hospital, except obstetrics and gynecology cases, were included in the study. Demographic characteristics, nutritional status, preoperative and intraoperative conditions, wound contamination/SSI type, and mortality data were reported. RESULTS From 4,893 abdominal surgeries during the period, 135 subjects (2.8%) developed SSI with 42.2% of cases were the clean-contaminated type. Most of the cases were males (66.7%), aged between 25–65 years old (80.0%), subjective goal assessment B (46.7%), had normal weight (57.8%), had longer duration of surgery (70.4%), and had preoperative stay between 2–15 days (65.2%). Most of the SSI patients survived (77.8%). CONCLUSIONS Even though the SSI in Cipto Mangunkusumo Hospital was low, it still needs improvement in preoperative care, intraoperative care, and SSI awareness. Therefore, further studies are required to understand how to reduce the incidence, risk, and SSI-related mortality.

Benchmarking for surgical site infections among gastrointestinal surgeries and related risk factors: multicenter study in Kuwait

Purpose

To measure surgical site infection (SSI) rates among gastrointestinal surgeries and to identify the associated risk factors.

Patients and methods

We conducted a multicenter, retrospective, surveillance-based study of adults undergoing gastric, colon, and small bowel (SB) procedures from January to December 2016. Univariate and multivariate analyses were conducted to determine the predictive variables in each surgery.

Results

In total, 71 of 2,099 patients developed SSI – 0.8%, 19.8%, and 10.8% following gastric, colon, and SB surgeries, respectively. In gastric surgery, the risk factors identified by univariate analysis were age, duration, wound class, risk index, emergency, and scope use (P<0.05). Logistic regression analysis revealed that the laparoscopic approach was the only significant predictor, with an inverse relationship of SSI rate vs open gastric surgery (P<0.05). Prolonged duration was a significant risk factor for developing SSI in colon surgery, and emergency was a significant risk for development of SSI in SB surgery. Gram-negative bacilli were the main causative pathogens, with a high percentage of multidrug-resistant organisms.

Conclusion

Variances in SSI rates and risk factors among gastric, colon, and SB surgery were detected. The use of an endoscope in gastric surgeries exhibited a protective effect against the development of SSI. The reduction of the SSI rate can be achieved by targeted preventive interventions for the identified risk factors.

Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience

PURPOSE

Surgical site infection (SSI) is the most common complication of colorectal surgery, resulting in significant burden in terms of morbidity and length of hospital stay. The aims of this study were to establish the incidence of SSI in patients undergoing colorectal surgeries and to identify potentially modifiable risk factors to reduce overall SSI rates.

METHODS

This retrospective study analyzed patients who underwent colorectal resection at our Department. Patients were identified using a prospective SSI database. Univariate and multivariate analyses were used to identify risk factors.

RESULTS

A total of 687 patients were enrolled in the study and the overall SSI rate was 19.9% (137 patients). Superficial incisional surgical site infections (SSSIs) developed in 52 (7.6%) patients, deep incisional surgical site infections (DSSIs) developed in 15 (2.2%), and organ/space infections (OSIs) developed in 70 (10.1%). Univariate and multivariate analyses confirmed that age, diabetes, emergency surgery, and a high infection risk index are risk factors for SSI.

CONCLUSIONS

There are some modifiable and non-modifiable risk factors for SSI. IRI and age are non-modifiable, whereas the timing of surgery and diabetes can be modulated by trying to defer some emergency procedures to elective ones and normalizing the glycemia of diabetic patients.

Perioperative Increase in Neutrophil CD64 Expression is an Indicator for Intra-abdominal Infection after Colorectal Cancer Surgery

BACKGROUND

Colorectal surgery is associated with a high incidence of postoperative infections. Early clinical signs are difficult to distinguish from the systemic inflammatory response related to surgical trauma. Timely diagnosis may significantly improve the outcome. The objective of this study was to compare a new biomarker index CD64 for neutrophils (iCD64n) with standard biomarkers, white blood cell (WBC) count, neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP) and procalcitonin (PCT) for the early detection of postoperative infection.

METHODS

The prospective study included 200 consecutive patients with elective colorectal cancer surgery. Postoperative values of biomarkers from the postoperative day (POD) 1 to POD5 were analysed by the receiver operating characteristic (ROC) analysis to predict infection. The Cox regression model and the Kaplan-Meier method were used to assess prognostic factors and survival.

RESULTS

The increase of index CD64n (iCD64n) after surgery, expressed as the ratio iCD64n after/before surgery was a better predictor of infection than its absolute value. The best 30-day predictors of all infections were CRP on POD4 (AUC 0.72, 99% CI 0.61-0.83) and NLR on POD5 (AUC 0.69, 99% CI 0.57-0.80). The best 15-day predictors of organ/space surgical site infection (SSI) were the ratio iCD64n on POD1 (AUC 0.72, 99% CI 0.58-0.86), POD3 (AUC 0.73, 99% CI 0.59-0.87) and CRP on POD3 (AUC 0.72, 99% CI 0.57-0.86), POD4 (AUC 0.79, 99% CI 0.64-0.93). In a multivariate analysis independent risk factors for infections were duration of surgery and perioperative transfusion while the infection itself was identified as a risk factor for a worse long-term survival.

CONCLUSIONS

The ratio iCD64n on POD1 is the best early predictor of intra-abdominal infection after colorectal cancer surgery. CRP predicts the infection with the same predictive value on POD3.

Preoperative oral antibiotics reduce infections after colorectal cancer surgery

Aim

The objectives were to recognize the risk factors for surgical site infections (SSIs) after surgery due to colorectal cancer and to assess the impact of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (ABX) on SSIs.

Methods

Records from two colorectal centers were used. Risk factors of SSIs were categorized into patient-, disease-, and treatment-dependent.

Results

A group of 2240 patients was included. SSIs were noted in 364 patients (16.3 %). MBP+/ABX+ was connected with a lower incidence of anastomotic leak (AL) and organ-space SSIs: 2.4 vs. 6.3 %; p = 0.008 and 3.6 vs. 7.2 %; p = 0.017, respectively. Patient-dependent factors: obesity increased the risk of skin superficial SSIs, adjusted OR 1.53 (1.47–1.59 95 % confidence interval (95 % CI)), and deep incisional SSIs 1.42 (1.39–1.45 95 % CI). Disease-dependent factors: rectal cancer was associated with a higher risk of skin superficial and deep incisional SSIs, adjusted OR 1.28 (1.22–1.34 95 % CI) and 1.13 (1.09–1.15 95 % CI). Treatment-dependent factors: MBP+/ABX+ was associated with a lower risk of organ-space SSIs, adjusted OR 0.53 (0.44–0.59 95 % CI). Radiotherapy increased the risk of organ-space SSIs, adjusted OR 1.78 (1.75–1.80 95 % CI). The risk of organ-space SSIs was the highest after low anterior resection, adjusted OR 1.62 (1.60–1.64 95 % CI).

Conclusions

If possible, MBP and ABX should always be administered to decrease the risk of AL and organ-space SSIs. Factors strictly related to the treatment mostly increased the risk of organ-space SSIs.

Sepsis following cancer surgery: the need for early recognition and standardised clinical care

Despite the implementation of multimodal bundles of care in hospitalised patients, post-operative sepsis in patients with cancer still accounts for a significant burden of illness and substantial healthcare costs. Patients undergoing surgery for cancer are at particular risk of sepsis due to underlying malignancy, being immunocompromised associated with cancer management and the complexity of surgical procedures performed. In this review, we evaluate the burden of illness and risks for sepsis following surgery for cancer. Current evidence supporting standardised strategies for sepsis management (including early recognition and resuscitation) is examined together with challenges in implementing quality improvement programs.