Skip to main content Accessibility help
×
×
Home

Risk of Surgical Site Infection (SSI) following Colorectal Resection Is Higher in Patients With Disseminated Cancer: An NCCN Member Cohort Study

  • Mini Kamboj (a1), Teresa Childers (a1), Jessica Sugalski (a2), Donna Antonelli (a3), Juliane Bingener-Casey (a4), Jamie Cannon (a5), Karie Cluff (a6), Kimberly A. Davis (a7), E. Patchen Dellinger (a8), Sean C. Dowdy (a9), Kim Duncan (a10), Julie Fedderson (a10), Robert Glasgow (a11), Bruce Hall (a12), Marilyn Hirsch (a13), Matthew Hutter (a14), Lisa Kimbro (a2), Boris Kuvshinoff (a15), Martin Makary (a16), Melanie Morris (a5), Sharon Nehring (a17), Sonia Ramamoorthy (a18), Rebekah Scott (a18), Mindy Sovel (a19), Vivian Strong (a19), Ashley Webster (a20), Elizabeth Wick (a16), Julio Garcia Aguilar (a19), Robert Carlson (a2) and Kent Sepkowitz (a1) (a21)...

Abstract

BACKGROUND

Surgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.

OBJECTIVE

To examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRS

DESIGN

American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011–2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.

SETTING

Multicenter study

PARTICIPANTS

Of 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

MAIN OUTCOME

The primary outcome of interest was 30-day SSI rate.

RESULTS

A total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23–2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09–1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06–2.53; P=.02), and longer duration of procedure were associated with development of SSI.

CONCLUSIONS

Patients with disseminated cancer are at a higher risk for developing SSI. ASA score >3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.

Infect Control Hosp Epidemiol 2018;39:555–562

Copyright

Corresponding author

Address correspondence to Mini Kamboj, MD, 1275 York Avenue, New York, NY 10065 (kambojm@mskcc.org).

Footnotes

Hide All
a

Authors of equal contribution.

Footnotes

References

Hide All
1. Key statistics for colorectal cancer. American Cancer Society website. http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics. Accessed November 20, 2016.
2. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160166.
3. Anderson, DJ, Kaye, KS, Classen, D, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(Suppl 1):S51S61.
4. Malone, DL, Genuit, T, Tracy, JK, Gannon, C, Napolitano, LM. Surgical site infections: reanalysis of risk factors. J Surg Res 2002;103:8995.
5. Anderson, DJ, Podgorny, K, Berrios-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605627.
6. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:11981208.
7. Tang, R, Chen, HH, Wang, YL, et al. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg 2001;234:181189.
8. Ju, MH, Ko, CY, Hall, BL, Bosk, CL, Bilimoria, KY, Wick, EC. A comparison of 2 surgical site infection monitoring systems. JAMA Surg 2015;150:5157.
9. Serra-Aracil, X, Garcia-Domingo, MI, Pares, D, et al. Surgical site infection in elective operations for colorectal cancer after the application of preventive measures. Arch Surg 2001;146:606612.
10. Khuri, SF, Daley, J, Henderson, W, et al. The Department of Veterans Affairs NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 1998;228:491507.
11. Cohen, ME, Ko, CY, Bilimoria, KY, et al. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 2013;217:336346.
12. Henderson, WG, Daley, J. Design and statistical methodology of the National Surgical Quality Improvement Program: Why is it what it is? Am J Surg 2009;198:S19S27.
13. Data collection, analysis, and reporting. American Cancer Society NSQIP website. https://www.facs.org/quality-programs/acs-nsqip/program-specifics/data. Accessed July 25, 2016.
14. Healthcare-associated infections. Medicare.gov website. https://www.medicare.gov/hospitalcompare/Data/Healthcare-Associated-Infections.html. Accessed July 25, 2016.
15. Mu, Y, Edwards, JR, Horan, TC, Berrios-Torres, SI, Fridkin, SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol 2011;32:970986.
16. Bot, J, Piessen, G, Robb, WB, Roger, V, Mariette, C. Advanced tumor stage is an independent risk factor of postoperative infectious complications after colorectal surgery: arguments from a case-matched series. Dis Colon Rectum 2013;56:568576.
17. Segal, CG, Waller, DK, Tilley, B, Piller, L, Bilimoria, K. An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery. Surgery 2014;156:12531260.
18. Reducing colorectal surgical site infections. Joint Commission Center for Transforming Health Care website. https://www.centerfortransforminghealthcare.org/assets/4/6/SSI_storyboard.pdf. Published 2014. Accessed February 9, 2018.
19. Sehgal, R, Berg, A, Figueroa, R, et al. Risk factors for surgical site infections after colorectal resection in diabetic patients. J Am Coll Surg 2011;212:2934.
20. Kwon, S, Thompson, R, Dellinger, P, Yanez, D, Farrohki, E, Flum, D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg 2013;257:814.
21. Pomposelli, JJ, Baxter, JK 3d, Babineau, TJ, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. J Parenter Enteral Nutr 1998;22:7781.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
WORD
Supplementary materials

Kamboj et al. supplementary material
Tables S1 and S2

 Word (17 KB)
17 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed