O21 – Complex pelvic surgery and additional organ resection independently increase the risk of wound infection after elective colorectal surgery: an ACS-NSQIP analysis
Author(s):
Background: Determining significant predictors of surgical site infection (SSI) in a large cohort is important for the design of accurate SSI surveillance programs.
Hypothesis: Additional organ resection is independently associated with a higher risk of SSI.
Methods: Patients in ACS-NSQIP (2005-12) were identified (n=112282). Wound infection (superficial or deep SSI) at 30 days was the primary outcome (dependent variable). Using secondary CPT codes, additional organ resection was defined as: bladder resection/repair, hysterectomy, partial vaginectomy, additional segmental colon, small bowel, gastric, or diaphragm resection. Univariate analysis of patient and procedure factors identified significant (p<0.05) predictors, which were modeled using stepwise logistic regression.
Results: The rate of wound infection was 9.2%. Strongest predictors of wound infection were high BMI (Table), bowel obstruction (OR) =1.48), inflammatory bowel disease (OR=1.35), open surgery (OR=1.78), pelvic exenteration (OR=1.48) and abdominoperineal resection (APR) (OR=1.67). Additional organ resection was independently associated (OR=1.19). Other risk factors are shown in the Table.
Conclusions: In addition to other factors, complex pelvic surgery and additional organ resection are independently associated with a higher risk of SSI. In these established high-risk subgroups of patients, aggressive interventions to prevent SSI should be considered.