Wound Infection after Elective Colorectal Resection

Robert L. Smith, Jamie K. Bohl, Shannon T. McElearney, Charles M. Friel, Margaret M. Barclay, Robert G. Sawyer, Eugene F. Foley, R. Phillip Burns, Thomas R. Gadacz, Hiram C. Polk, John M. Kellum, Richard J. Howard, Galen V. Poole, Raleigh R. White IV, Basil A. Pruitt

Research output: Contribution to journalArticle

Abstract

Introduction: Surgical site infection (SSI) is a potentially morbid and costly complication following major colorectal resection. In recent years, there has been growing attention placed on the accurate identification and monitoring of such surgical complications and their costs, measured in terms of increased morbidity to patients and increased financial costs to society. We hypothesize that incisional SSIs following elective colorectal resection are more frequent than is generally reported in the literature, that they can be predicated by measurable perioperative factors, and that they carry substantial morbidity and cost. Methods: Over a 2-year period at a university hospital, data on all elective colorectal resections performed by a single surgeon were retrospectively collected. The outcome of interest was a diagnosis of incisional SSI as defined by the Center of Disease Control and Prevention. Variables associated with infection, as identified in the literature or by experts, were collected and analyzed for their association with incisional SSI development in this patient cohort. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI by univariate analysis to determine their prognostic significance. The incidence of SSI in this study was compared with the rates of incisional SSI in this patient population reported in the literature, predicted by a nationally based system monitoring nosocomial infection, and described in a prospectively acquired intradepartmental surgical infection data base at our institution. Results: One hundred seventy-six patients undergoing elective colorectal resection were identified for evaluation. The mean patient age was 62 ± 1.2 years, and 54% were men. Preoperative diagnoses included colorectal cancer (57%), inflammatory bowel disease (20%), diverticulitis (10%), and benign polyp disease (5%). SSIs were identified in 45 patients (26%). Twenty-two (49%) SSIs were detected in the outpatient setting following discharge. Of all preoperative and perioperative variables measured, increasing patient body mass index and intraoperative hypotension independently predicted incisional SSI. Although we could not measure statistically increased length of hospital stay associated with SSI, a representative population of patients with SSI accumulated a mean of $6200/patient of home health expenses related to wound care. Our rates of SSI were substantially higher than that reported generally in the literature, predicted by the National Nosocomial Infection System, or described by our own institutional surgical infection data base. Conclusions: The incidence of incisional SSI in patients undergoing elective colorectal resection in our cohort was substantially higher than generally reported in the literature, the NNIS or predicted by an institutional surgical infection complication registry. Although some of these differences may be attributable to patient population differences, we believe these discrepancies highlight the potential limitations of systematic outcomes measurement tools which are independent of the primary clinical care team. Accurate surgical complication documentation by the primary clinical team is critical to identify the true frequency and etiology of surgical complications such as incisional SSI, to rationally approach their reduction and decrease their associated costs to patients and the health care system.

Original languageEnglish (US)
Pages (from-to)599-607
Number of pages9
JournalAnnals of Surgery
Volume239
Issue number5
DOIs
StatePublished - May 2004
Externally publishedYes

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Surgical Wound Infection
Wound Infection
Costs and Cost Analysis
Cross Infection
Infection
Length of Stay
Databases
Population
Morbidity
Patient Advocacy
Diverticulitis
Incidence
Centers for Disease Control and Prevention (U.S.)
Polyps
Documentation
Hypotension
Registries
Colorectal Neoplasms
Primary Health Care
Patient Care

ASJC Scopus subject areas

  • Surgery

Cite this

Smith, R. L., Bohl, J. K., McElearney, S. T., Friel, C. M., Barclay, M. M., Sawyer, R. G., ... Pruitt, B. A. (2004). Wound Infection after Elective Colorectal Resection. Annals of Surgery, 239(5), 599-607. https://doi.org/10.1097/01.sla.0000124292.21605.99

Wound Infection after Elective Colorectal Resection. / Smith, Robert L.; Bohl, Jamie K.; McElearney, Shannon T.; Friel, Charles M.; Barclay, Margaret M.; Sawyer, Robert G.; Foley, Eugene F.; Burns, R. Phillip; Gadacz, Thomas R.; Polk, Hiram C.; Kellum, John M.; Howard, Richard J.; Poole, Galen V.; White IV, Raleigh R.; Pruitt, Basil A.

In: Annals of Surgery, Vol. 239, No. 5, 05.2004, p. 599-607.

Research output: Contribution to journalArticle

Smith, RL, Bohl, JK, McElearney, ST, Friel, CM, Barclay, MM, Sawyer, RG, Foley, EF, Burns, RP, Gadacz, TR, Polk, HC, Kellum, JM, Howard, RJ, Poole, GV, White IV, RR & Pruitt, BA 2004, 'Wound Infection after Elective Colorectal Resection', Annals of Surgery, vol. 239, no. 5, pp. 599-607. https://doi.org/10.1097/01.sla.0000124292.21605.99
Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG et al. Wound Infection after Elective Colorectal Resection. Annals of Surgery. 2004 May;239(5):599-607. https://doi.org/10.1097/01.sla.0000124292.21605.99
Smith, Robert L. ; Bohl, Jamie K. ; McElearney, Shannon T. ; Friel, Charles M. ; Barclay, Margaret M. ; Sawyer, Robert G. ; Foley, Eugene F. ; Burns, R. Phillip ; Gadacz, Thomas R. ; Polk, Hiram C. ; Kellum, John M. ; Howard, Richard J. ; Poole, Galen V. ; White IV, Raleigh R. ; Pruitt, Basil A. / Wound Infection after Elective Colorectal Resection. In: Annals of Surgery. 2004 ; Vol. 239, No. 5. pp. 599-607.
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abstract = "Introduction: Surgical site infection (SSI) is a potentially morbid and costly complication following major colorectal resection. In recent years, there has been growing attention placed on the accurate identification and monitoring of such surgical complications and their costs, measured in terms of increased morbidity to patients and increased financial costs to society. We hypothesize that incisional SSIs following elective colorectal resection are more frequent than is generally reported in the literature, that they can be predicated by measurable perioperative factors, and that they carry substantial morbidity and cost. Methods: Over a 2-year period at a university hospital, data on all elective colorectal resections performed by a single surgeon were retrospectively collected. The outcome of interest was a diagnosis of incisional SSI as defined by the Center of Disease Control and Prevention. Variables associated with infection, as identified in the literature or by experts, were collected and analyzed for their association with incisional SSI development in this patient cohort. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI by univariate analysis to determine their prognostic significance. The incidence of SSI in this study was compared with the rates of incisional SSI in this patient population reported in the literature, predicted by a nationally based system monitoring nosocomial infection, and described in a prospectively acquired intradepartmental surgical infection data base at our institution. Results: One hundred seventy-six patients undergoing elective colorectal resection were identified for evaluation. The mean patient age was 62 ± 1.2 years, and 54{\%} were men. Preoperative diagnoses included colorectal cancer (57{\%}), inflammatory bowel disease (20{\%}), diverticulitis (10{\%}), and benign polyp disease (5{\%}). SSIs were identified in 45 patients (26{\%}). Twenty-two (49{\%}) SSIs were detected in the outpatient setting following discharge. Of all preoperative and perioperative variables measured, increasing patient body mass index and intraoperative hypotension independently predicted incisional SSI. Although we could not measure statistically increased length of hospital stay associated with SSI, a representative population of patients with SSI accumulated a mean of $6200/patient of home health expenses related to wound care. Our rates of SSI were substantially higher than that reported generally in the literature, predicted by the National Nosocomial Infection System, or described by our own institutional surgical infection data base. Conclusions: The incidence of incisional SSI in patients undergoing elective colorectal resection in our cohort was substantially higher than generally reported in the literature, the NNIS or predicted by an institutional surgical infection complication registry. Although some of these differences may be attributable to patient population differences, we believe these discrepancies highlight the potential limitations of systematic outcomes measurement tools which are independent of the primary clinical care team. Accurate surgical complication documentation by the primary clinical team is critical to identify the true frequency and etiology of surgical complications such as incisional SSI, to rationally approach their reduction and decrease their associated costs to patients and the health care system.",
author = "Smith, {Robert L.} and Bohl, {Jamie K.} and McElearney, {Shannon T.} and Friel, {Charles M.} and Barclay, {Margaret M.} and Sawyer, {Robert G.} and Foley, {Eugene F.} and Burns, {R. Phillip} and Gadacz, {Thomas R.} and Polk, {Hiram C.} and Kellum, {John M.} and Howard, {Richard J.} and Poole, {Galen V.} and {White IV}, {Raleigh R.} and Pruitt, {Basil A.}",
year = "2004",
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language = "English (US)",
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TY - JOUR

T1 - Wound Infection after Elective Colorectal Resection

AU - Smith, Robert L.

AU - Bohl, Jamie K.

AU - McElearney, Shannon T.

AU - Friel, Charles M.

AU - Barclay, Margaret M.

AU - Sawyer, Robert G.

AU - Foley, Eugene F.

AU - Burns, R. Phillip

AU - Gadacz, Thomas R.

AU - Polk, Hiram C.

AU - Kellum, John M.

AU - Howard, Richard J.

AU - Poole, Galen V.

AU - White IV, Raleigh R.

AU - Pruitt, Basil A.

PY - 2004/5

Y1 - 2004/5

N2 - Introduction: Surgical site infection (SSI) is a potentially morbid and costly complication following major colorectal resection. In recent years, there has been growing attention placed on the accurate identification and monitoring of such surgical complications and their costs, measured in terms of increased morbidity to patients and increased financial costs to society. We hypothesize that incisional SSIs following elective colorectal resection are more frequent than is generally reported in the literature, that they can be predicated by measurable perioperative factors, and that they carry substantial morbidity and cost. Methods: Over a 2-year period at a university hospital, data on all elective colorectal resections performed by a single surgeon were retrospectively collected. The outcome of interest was a diagnosis of incisional SSI as defined by the Center of Disease Control and Prevention. Variables associated with infection, as identified in the literature or by experts, were collected and analyzed for their association with incisional SSI development in this patient cohort. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI by univariate analysis to determine their prognostic significance. The incidence of SSI in this study was compared with the rates of incisional SSI in this patient population reported in the literature, predicted by a nationally based system monitoring nosocomial infection, and described in a prospectively acquired intradepartmental surgical infection data base at our institution. Results: One hundred seventy-six patients undergoing elective colorectal resection were identified for evaluation. The mean patient age was 62 ± 1.2 years, and 54% were men. Preoperative diagnoses included colorectal cancer (57%), inflammatory bowel disease (20%), diverticulitis (10%), and benign polyp disease (5%). SSIs were identified in 45 patients (26%). Twenty-two (49%) SSIs were detected in the outpatient setting following discharge. Of all preoperative and perioperative variables measured, increasing patient body mass index and intraoperative hypotension independently predicted incisional SSI. Although we could not measure statistically increased length of hospital stay associated with SSI, a representative population of patients with SSI accumulated a mean of $6200/patient of home health expenses related to wound care. Our rates of SSI were substantially higher than that reported generally in the literature, predicted by the National Nosocomial Infection System, or described by our own institutional surgical infection data base. Conclusions: The incidence of incisional SSI in patients undergoing elective colorectal resection in our cohort was substantially higher than generally reported in the literature, the NNIS or predicted by an institutional surgical infection complication registry. Although some of these differences may be attributable to patient population differences, we believe these discrepancies highlight the potential limitations of systematic outcomes measurement tools which are independent of the primary clinical care team. Accurate surgical complication documentation by the primary clinical team is critical to identify the true frequency and etiology of surgical complications such as incisional SSI, to rationally approach their reduction and decrease their associated costs to patients and the health care system.

AB - Introduction: Surgical site infection (SSI) is a potentially morbid and costly complication following major colorectal resection. In recent years, there has been growing attention placed on the accurate identification and monitoring of such surgical complications and their costs, measured in terms of increased morbidity to patients and increased financial costs to society. We hypothesize that incisional SSIs following elective colorectal resection are more frequent than is generally reported in the literature, that they can be predicated by measurable perioperative factors, and that they carry substantial morbidity and cost. Methods: Over a 2-year period at a university hospital, data on all elective colorectal resections performed by a single surgeon were retrospectively collected. The outcome of interest was a diagnosis of incisional SSI as defined by the Center of Disease Control and Prevention. Variables associated with infection, as identified in the literature or by experts, were collected and analyzed for their association with incisional SSI development in this patient cohort. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI by univariate analysis to determine their prognostic significance. The incidence of SSI in this study was compared with the rates of incisional SSI in this patient population reported in the literature, predicted by a nationally based system monitoring nosocomial infection, and described in a prospectively acquired intradepartmental surgical infection data base at our institution. Results: One hundred seventy-six patients undergoing elective colorectal resection were identified for evaluation. The mean patient age was 62 ± 1.2 years, and 54% were men. Preoperative diagnoses included colorectal cancer (57%), inflammatory bowel disease (20%), diverticulitis (10%), and benign polyp disease (5%). SSIs were identified in 45 patients (26%). Twenty-two (49%) SSIs were detected in the outpatient setting following discharge. Of all preoperative and perioperative variables measured, increasing patient body mass index and intraoperative hypotension independently predicted incisional SSI. Although we could not measure statistically increased length of hospital stay associated with SSI, a representative population of patients with SSI accumulated a mean of $6200/patient of home health expenses related to wound care. Our rates of SSI were substantially higher than that reported generally in the literature, predicted by the National Nosocomial Infection System, or described by our own institutional surgical infection data base. Conclusions: The incidence of incisional SSI in patients undergoing elective colorectal resection in our cohort was substantially higher than generally reported in the literature, the NNIS or predicted by an institutional surgical infection complication registry. Although some of these differences may be attributable to patient population differences, we believe these discrepancies highlight the potential limitations of systematic outcomes measurement tools which are independent of the primary clinical care team. Accurate surgical complication documentation by the primary clinical team is critical to identify the true frequency and etiology of surgical complications such as incisional SSI, to rationally approach their reduction and decrease their associated costs to patients and the health care system.

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