ABDOMINAL COMPARTMENT SYNDROME, CEREBRAL INFARCTION, AND ACUTE RESPIRATORY DISTRESS SYNDROME ARE THE BIGGEST MODIFIABLE RISK FACTORS FOR SURGICAL SITE INFECTIONS IN BLUNT TRAUMATIC HEMORRHAGIC SHOCK

Author(s):
John Hwabejire, MD, MPH; Christine Nembhard, MD; Tolulope Oyetunji, MD, MPH; Theodros Seyoum, MD; Olumayoma Pitan, MD; Suryanarayana Siram, MD; Edward Cornwell III, MD; Wendy Greene, MD, Howard University Hospital, Washington, DC

Background:

Infections are key contributors to the trimodal distribution of traumatic deaths. However, the factors that increase surgical site infection (SSI) risks after operative interventions in traumatic hemorrhagic shock (HS) are incompletely defined. We identified variables that increase SSI risks in blunt traumatic HS

Hypothesis:

Modifiable factors after HS are associated with increased SSI risks

Methods:

The Glue grant database was analyzed. Patients aged≥16 who had surgery and survived were included. Those who developed an SSI (SSIs) were compared with those who did not (No-SSIs). Univariate and multivariate analyses were used to determine predictors of developing an SSI

Results:

1552 patients were included, out of which 240 (15.5%) had an SSI. There was no difference in age, gender, race, pre-injury comorbidities and Injury Severity Score between SSIs and No-SSIs. Compared to No-SSIs, SSIs had a higher initial heart rate (114±27vs110±26, p=0.012), lactate (4.7±2.5vs4.1±2.4, p=0.001), INR (1.5±0.7vs1.4±0.4, p<0.001), multiple organ failure score (6.1±2.5vs4.8±2.2, p<0.001), volume of transfused blood (3252±3086mLvs 2152±2250, p<0.001), volume of crystalloids (12994±7290vs10210±5202, p<0.001), hospital length of stay in days (41±36 vs. 24±20, p<0.001), ICU days (21±17 vs. 13±11, p<0.001), and ICU ventilation days (16±15 vs. 9±10, p<0.001). SSIs also had a higher incidence of abdominal compartment syndrome, ACS (13.8% vs. 3.3%, p<0.001), acute respiratory distress syndrome, ARDS (38.3% vs. 19.9%, p<0.001), cerebral infarction (5.4% vs. 1.6%, p=0.001), extremity compartment syndrome (5.4% vs. 2.8%, p=0.038), and rhabdomyolysis (7.5% vs. 2.1%, p<0.001). Laparotomy (Pearson’s R=0.081, p=0.001), soft tissue debridement (Pearson’s R=0.197, p<0.001) and thoracotomy (Pearson’s R=0.097, p<0.001) correlated positively with SSI. Independent predictors of having an SSI include cerebral infarction (OR:2.92,CI:1.31-6.50, p=0.009), ACS (OR:2.37,CI:1.33-4.23, p=0.004), ARDS (OR:1.63,CI:1.12-2.39, p=0.012), laparotomy (OR:1.47,CI:1.04-2.08, p=0.031), soft tissue debridement (OR:2.87,CI:2.03-4.05, p<0.001), and thoracotomy (OR:1.94,CI:1.18-3.21, p=0.009). The rate of SSI was 43.4% in patients with ACS, 38.2% in those with cerebral infarction and 26.1% in those with ARDS

Conclusions:

ACS, ARDS and cerebral infarction are the major modifiable risk factors for the development of SSIs after life saving surgical interventions for blunt traumatic HS and represent targets for reduction of SSI-associated morbidity and mortality