J. T. Wiseman1, S. Fernandes-Taylor1, K. C. Kent1 1University Of Wisconsin,Wisconsin Surgical Outcomes Research Program,Madison, WI, USA
Introduction: Surgical site infection (SSI) after colorectal surgery is one of the most common post-operative complications producing substantial morbidity and mortality. A significant proportion of SSI develops after hospital discharge suggesting that transitional care interventions to detect early SSI may help stem the burden of readmission. Although data are available regarding SSI following colectomy, little is known regarding the classification of patients at high-risk for development of SSI occurring after hospital discharge.
Methods: Patients who underwent colectomy from 2005-2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files. Patients were categorized as having no SSI, SSI occurring in-hospital, or SSI after hospital discharge. Multivariable logistic regression was performed using pre and perioperative variables to predict in-hospital SSI and post-discharge SSI.
Results: Of the 141,877 patients who underwent colectomy, 14,694 (10.4%) were diagnosed with SSI (4.9% in-hospital; 5.4% post-discharge). Multivariate predictors of both in-hospital and post-discharge SSI include obesity and overweight vs. normal BMI, operative time >4 hours vs. 2-4 hours, smoking, American Society of Anesthesiologists (ASA) classification >2, contaminated vs. clean or clean/contaminated wound classification, steroid use and dyspnea. Multivariate predictors unique to patients who experienced in-hospital SSI include black or other race vs. white race, dirty vs. clean or clean/contaminated wound classification, chronic obstructive pulmonary disease (COPD), and disseminated cancer. Multivariate predictors unique to patients who experienced post-discharge SSI include diabetes and female gender (table).
Conclusions: Our data demonstrate that the majority of predictors for SSI after colectomy are similar during both in-hospital and post-discharge periods. This suggests early identification of patients possessing these risk factors at the time of surgery, in particular obesity, may improve both in-hospital wound surveillance and subsequent transitional care efforts to improve wound monitoring and decrease incidence of severe SSI.
