Hostname: page-component-7479d7b7d-qs9v7 Total loading time: 0 Render date: 2024-07-08T12:29:46.770Z Has data issue: false hasContentIssue false
  • English
  • Français

Surveillance of surgical site infection after colorectal surgery: comprehensiveness and impact of risk factors

Published online by Cambridge University Press:  22 March 2023

Rui M. Malheiro Open the ORCID record for Rui M. Malheiro [Opens in a new window] ,
Bárbara Peleteiro Open the ORCID record for Bárbara Peleteiro [Opens in a new window] ,
Goreti Silva ,
Ana Lebre Open the ORCID record for Ana Lebre [Opens in a new window] ,
José Artur Paiva Open the ORCID record for José Artur Paiva [Opens in a new window]  and
Sofia Correia Open the ORCID record for Sofia Correia [Opens in a new window]
Rui M. Malheiro*
Affiliation:
EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
Bárbara Peleteiro
Affiliation:
EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal Departmento de Saúde Pública, Ciências forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
Goreti Silva
Affiliation:
Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde, Lisboa, Portugal
Ana Lebre
Affiliation:
Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde, Lisboa, Portugal Instituto Português de Oncologia do Porto Francisco Gentil, E.E., Porto, Portugal
José Artur Paiva
Affiliation:
Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos (PPCIRA), Direção-Geral de Saúde, Lisboa, Portugal Unidade de Cuidados Intensivos, Centro Hospitalar Universitário São João, Porto, Portugal Departmento de Medicina, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
Sofia Correia
Affiliation:
Departmento de Saúde Pública, Ciências forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal
*
Author for correspondence: Rui M. Malheiro, E-mail: rui.coelho@arsnorte.min-saude.pt
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The incidence of surgical site infection (SSI) is highest after colorectal surgery. We assessed the impact of risk factors for SSI using the population attributable fraction (PAF).

Design:

Retrospective cohort study.

Setting:

Portuguese hospitals performing regular surveillance.

Patients:

We identified patients who underwent colorectal procedures in hospitals that reported colorectal surgeries every year between 2015 and 2019. Among 42 reporting hospitals, 18 hospitals were included.

Methods:

Risk-factor incidence was estimated using the National Epidemiological Surveillance platform from 2015 to 2019. This platform follows the methodology recommended by the European Centre for Disease Prevention and Control. American Society of Anaesthesiologists (ASA) physical classification, wound classification, open surgery, urgent operation, antibiotic prophylaxis, operation time, and male sex were included as risk factors. Measures of association were retrieved from published meta-analyses. PAFs were calculated using the Levin formula. To account for interaction between risk factors, communality of risk factors was used in a weighted-sum approach, providing a combined value that serves as a measure of the comprehensiveness of surveillance.

Results:

Among 11,219 reported procedures, the cumulative SSI incidence was 16.8%. The proportion of SSI attributed to all risk factors was 61%. Modifiable variables accounted for 31% of procedures; the highest was laparotomy (16.8%), and urgent operations (2.7%) had the lowest value. Nonmodifiable factors accounted for 28.7%; the highest was wound classification (14.3%).

Conclusions:

A relevant proportion (39%) of SSI remains unaccounted for by current surveillance. Almost one-third of SSI cases have potentially modifiable factors. Interventions focusing on shorter, less invasive procedures may be optimally effective in reducing the SSI incidence.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 10 , October 2023 , pp. 1601 - 1606
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cassini, A, Plachouras, D, Eckmanns, T, et al. Burden of six healthcare-associated infections on european population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med 2016;13:e1002150.CrossRefGoogle ScholarPubMed
Badia, JM, Casey, AL, Petrosillo, N, Hudson, PM, Mitchell, SA, Crosby, C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect 2017;96:1–15.CrossRefGoogle ScholarPubMed
European Centre for Disease Prevention and Control. Healthcare-associated infections: surgical site infections. In: ECDC Annual Epidemiological Report for 2017. Stockholm: ECDC; 2019.Google Scholar
Ministério da Saúde, Direção-Geral da Saúde. Infeções e Resistências aos Antimicrobianos: Relatório Anual do Programa Prioritário 2018.Google Scholar
Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.CrossRefGoogle ScholarPubMed
STOP infeção hospitalar! Fundação Calouste Gulbenkian website. https://gulbenkian.pt/publications/stop-infecao-hospitalar-booklet. Published 2018. Accessed February 25, 2023.Google Scholar
European Centre for Disease Prevention and Control. Surveillance of surgical site infections and prevention indicators in European hospitals—HAI-Net SSI protocol, version 2.2. Stockholm: ECDC; 2017.Google Scholar
Thelwall, S, Harrington, P, Sheridan, E, Lamagni, T. Impact of obesity on the risk of wound infection following surgery: results from a nationwide prospective multicentre cohort study in England. Clin Microbiol Infect 2015;21:1008.e1–e8.CrossRefGoogle ScholarPubMed
Caroff, DA, Chan, C, Kleinman, K, et al. Association of open approach vs laparoscopic approach with risk of surgical site infection after colon surgery. JAMA Netw Open 2019;2:e1913570.CrossRefGoogle ScholarPubMed
Ishigami, J, Trevisan, M, Xu, H, et al. Estimated GFR and hospital-acquired infections following major surgery. Am J Kidney Dis 2019;73:11–20.CrossRefGoogle ScholarPubMed
Ribeiro, JC, Bellusse, GC, Martins de Freitas, IC, Galvão, CM. Effect of perioperative hypothermia on surgical site infection in abdominal surgery: a prospective cohort study. Int J Nurs Pract 2021;27:e12934.10.1111/ijn.12934CrossRefGoogle ScholarPubMed
Doyle, DJ, Goyal, A, Bansal, P, et al. American Society of Anesthesiologists Classification. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK441940/. Updated October 9, 2021. Accessed February 25, 2023.Google Scholar
Xu, Z, Qu, H, Gong, Z, et al. Risk factors for surgical site infection in patients undergoing colorectal surgery: a meta-analysis of observational studies. PLoS One 2021;16:e0259107.CrossRefGoogle ScholarPubMed
Hou, TY, Gan, H-Q, Zhou, J-F, et al. Incidence of and risk factors for surgical site infection after colorectal surgery: a multiple-center prospective study of 3,663 consecutive patients in China. Int J Infect Dis 2020;96:676–681.CrossRefGoogle ScholarPubMed
Herman, TF, Bordoni, B. Wound classification. In: StatPearls. Treasure Island, FL: StatPearls; 2022.Google Scholar
Altemeier, WA, Burke, JF, Pruitt, BA, Sandusky, WR. Manual on Control of Infection in Surgical Patients, Second Edition. Philadelphia: JB Lippincott; 1984.Google Scholar
Norma nº 031/2013 de 31 de dezembro, atualizada a 18 de dezembro de 2014. Direção-Geral da saúde.Google Scholar
Nelson, RL, Gladman, E, Barbateskovic, M. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 2014;5:CD001181.CrossRefGoogle Scholar
Levin, M. The occurrence of lung cancer in man. Acta Unio Internationalis Contra Cancrum 1953;9:531–541.Google ScholarPubMed
Benichou, J. A review of adjusted estimators of attributable risk. Statist Method Med Res 2001;10:195–216.CrossRefGoogle ScholarPubMed
Norton, S, Matthews, FE, Barnes, DE, Yaffe, K, Brayne, C. Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol 2014;13:788–794.CrossRefGoogle ScholarPubMed
Livingston, G, Sommerlad, A, Orgeta, V, et al. Dementia prevention, intervention, and care. Lancet 2017;390:2673–2734.CrossRefGoogle ScholarPubMed
Mukadam, N, et al. Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data. Lancet Global Health 2019;7:e596–e603.CrossRefGoogle ScholarPubMed
Ma’u, E, Cullum, S, Cheung, G, Livingston, G, Mukadam, N. Differences in the potential for dementia prevention between major ethnic groups within one country: a cross sectional analysis of population attributable fraction of potentially modifiable risk factors in New Zealand. Lancet Reg Health West Pac 2021;13:100191.Google Scholar
Ghadban, T, Reeh, M, Bockhorn, M, et al. Minimally invasive surgery for colorectal cancer remains underutilized in Germany despite its nationwide application over the last decade. Sci Rep 2018;8:15146.CrossRefGoogle ScholarPubMed
Stormark, K, Søreide, K, Søreide, JA, et al. Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort. Surg Endosc 2016;30:4853–4864.CrossRefGoogle Scholar
Arroyo-Garcia, N, Badia, JM, Vázquez, A, et al. An interventional nationwide surveillance program lowers postoperative infection rates in elective colorectal surgery. A cohort study (2008–2019). Int J Surg 2022;102:106611.CrossRefGoogle ScholarPubMed
Malheiro, R, Peleteiro, B, Correia, S. Beyond the operating room: do hospital characteristics have an impact on surgical site infections after colorectal surgery? A systematic review. Antimicrob Resist Infect Control 2021;10:139.CrossRefGoogle ScholarPubMed
What is a bundle? Institute for Healthcare Improvement website. http://www.ihiorgresourcesPagesImprovementStoriesWhatIsaBundleaspx 1–4. Published 2016. Accessed July 20, 2022.Google Scholar
Zywot, A, Lau, CSM, Fletcher, HS, Paul, S. Bundles Prevent surgical site infections after colorectal surgery: meta-analysis and systematic review. J Gastrointest Surg 2017;21:1915–1930.CrossRefGoogle ScholarPubMed
Pop-Vicas, AE, Abad, C, Baubie, K, Osman, F, Heise, C, Safdar, N. Colorectal bundles for surgical site infection prevention: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2020;41:805–812.CrossRefGoogle ScholarPubMed
Gastmeier, P, Schwab, F, Sohr, D, Behnke, M, Geffers, C. Reproducibility of the surveillance effect to decrease nosocomial infection rates. Infect Control Hosp Epidemiol 2009;30:993–999.CrossRefGoogle ScholarPubMed
Darrow, LA, Steenland, NK. Confounding and bias in the attributable fraction. Epidemiology 2011;22:53–58.CrossRefGoogle ScholarPubMed
Tabachnick, B, Fidell, L. Using Multivariate Statistics, Fifth Edition. Boston: Pearson Education; 2007.Google Scholar
Hennessey, DB, Burke, JP, Ni-Dhonochu, T, Shields, C, Winter, DC, Mealy, K. Risk factors for surgical site infection following colorectal resection: a multi-institutional study. Int J Colorectal Dis 2015;31:267–271.CrossRefGoogle ScholarPubMed
Supplementary material: File

Malheiro et al. supplementary material

Malheiro et al. supplementary material

Download Malheiro et al. supplementary material(File)
File 17.1 KB