Current outcomes and predictors of treatment failure in patients with surgical site infection after elective colorectal surgery. A multicentre prospective cohort study - 09/10/17
, Josep Ma Badia c, b , Jordi Carratalà a, b, d , Xavier Serra-Aracil e, b , Evelyn Shaw a, b , Vicens Diaz-Brito f , Antoni Castro g, b , Elena Espejo h, b , Carmen Nicolás i, b , Marta Piriz e, b , Montserrat Brugués j, b , Josefina Obradors k, b , Ana Lérida l, b , Jordi Cuquet c, b , Enric Limón b , Francesc Gudiol b, d , Miquel Pujol a, b, ⁎ on behalf of
VINCat Colon Surgery Group
Summary |
Objective |
To determine current outcomes and predictors of treatment failure among patients with surgical site infection (SSI) after colorectal surgery.
Methods |
A multicentre observational prospective cohort study of adults undergoing elective colorectal surgery in 10 Spanish hospitals (2011–2014). Treatment failure was defined as persistence of signs/symptoms of SSI or death at 30 days post-surgery.
Results |
Of 3701 patients, 669 (18.1%) developed SSI; 336 (9.1%) were organ-space infections. Among patients with organ-space SSI, 81.2% required source control: 60.4% reoperation and 20.8% percutaneous/transrectal drainage. Overall treatment failure rate was 21.7%: 9% in incisional SSIs and 34.2% in organ-space SSIs (p < 0.001). Median length of stay was 15 days (IQR 9–22) for incisional SSIs and 24 days (IQR 17–35) for organ-space SSIs (p < 0.001). One hundred and twenty-seven patients (19%) required readmission and 35 patients died (5.2%). Risk factors for treatment failure among patients with organ-space SSI were age ≥65 years (OR 1.83, 95% CI: 1.07–1.83), laparoscopy (OR 1.7, 95% CI: 1.06–2.77), and reoperation (OR 2.8, 95% CI: 1.7–4.6).
Conclusions |
Rates of SSI and treatment failure in organ-space SSI after elective colorectal surgery are notably high. Careful attention should be paid to older patients with previous laparoscopy requiring reoperation for organ-space SSI, so that treatment failure can be identified early.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Incidence of SSI after elective colorectal surgery in our cohort remained elevated. |
• | One third of patients with organ-space SSI had treatment failure at 30 days post-surgery. |
• | Treatment failure was associated with older age, laparoscopy and reoperation. |
Keywords : Surgical site infections, Organ-space surgical site infections, Colorectal diseases, Multidrug-resistant Gram-negative bacilli
Plan
Vol 74 - N° 6
P. 555-563 - juin 2017 Retour au numéro
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