Risk Factors for Organ Space Surgical Site Infections Requiring Intervention After Trauma Laparotomy

Author(s):
Stephanie Martinez Ugarte; Mokunfayo Fajemisin; Gabrielle Hatton; ERIN FOX; Lillian Kao

Background:

Blunt splenic injuries are increasingly being managed initially non-operatively, such that patients undergoing splenectomy may be more severely injured and at higher risk for complications. Since splenectomies are a clean operation, pre-incisional prophylaxis is typically not broad in spectrum. However, it is unknown what the current risk factors are for organ space surgical site infections (OS-SSIs) requiring intervention after splenectomy and whether the high-risk subset should receive broader spectrum antibiotics.

Hypothesis:

OS-SSIs requiring intervention after splenectomy for blunt trauma are associated with bowel injuries and largely caused by gram-negative organisms.

Methods:

A retrospective cohort study was performed of adults who underwent splenectomy for blunt trauma 7/2018-6/2023. Patients were excluded for death within 48 hours. Demographics, hospital course, pre-incisional antibiotic prophylaxis, and culture results were collected from the medical record. The primary outcome was OS-SSI requiring procedural intervention (Clavien-Dindo 3, CD3). Univariate and multivariable analyses were performed to evaluate risk factors for CD3 OS-SSIs.

Results:

Of 192 patients, 19 (10%) developed a CD3 OS-SSI. The median age of splenectomy patients was 41 (29, 56), and the injury severity score was 38 (27, 45). On univariate analysis, damage control laparotomy (DCL), large bowel injury, dirty wound class, longer operative (OR) time, and elevated heart rate (HR) on arrival were associated with OS-SSI. On adjusted analysis, HR on arrival, DCL, and dirty wound class were the strongest predictors of OS-SSI. Of 11 patients who had abscess cultures sent, the majority grew gram negative organisms. None of the cultured organisms in patients with CD3 OS-SSI were covered by the selected laparotomy antibiotic prophylaxis.

Conclusions:

In this single-center study, in severely injured patients undergoing splenectomy, the incidence of CD3 OS-SSIs was 10%, and infections were predominantly caused by gram-negative organisms. Splenectomy patients at high risk for OS-SSIs requiring intervention may benefit from broader spectrum pre-incisional antibiotic coverage.