Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-05T04:55:00.465Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical Site Infection Risk Factors Identified for Patients Undergoing Colon Procedures, New York State 2009–2010

Published online by Cambridge University Press:  10 May 2016

Boldtsetseg Tserenpuntsag ,
Valerie Haley ,
Carole Van Antwerpen ,
Diana Doughty ,
Kathleen A. Gase ,
Peggy Ann Hazamy  and
Marie Tsivitis
Boldtsetseg Tserenpuntsag*
Affiliation:
Hospital-Acquired Infection Reporting Program, New York State Department of Health, Albany, New York
Valerie Haley
Affiliation:
Hospital-Acquired Infection Reporting Program, New York State Department of Health, Albany, New York
Carole Van Antwerpen
Affiliation:
Hospital-Acquired Infection Reporting Program, New York State Department of Health, Albany, New York Retired
Diana Doughty
Affiliation:
Hospital-Acquired Infection Reporting Program, New York State Department of Health, Albany, New York Retired
Kathleen A. Gase
Affiliation:
Hospital-Acquired Infection Reporting Program, New York State Department of Health, Albany, New York
Peggy Ann Hazamy
Affiliation:
Hospital-Acquired Infection Reporting Program, New York State Department of Health, Albany, New York
Marie Tsivitis
Affiliation:
Hospital-Acquired Infection Reporting Program, New York State Department of Health, Albany, New York
*
Hospital-Acquired Infection Reporting Program, New York State Department of Health, Empire State Plaza, Room 523, Albany, NY 12137 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Extract

Background

Since 2007, New York State (NYS) hospitals have been required to report surgical site infections (SSIs) following colon procedures to the NYS Department of Health, using the National Healthcare Safety Network (NHSN). The purpose of this study was to identify risk factors for the development of SSIs in patients undergoing colon procedures.

Methods

NYS has been conducting validation studies at hospitals to assess the accuracy of the surveillance data reported by the participating hospitals. A sample of patients undergoing colon procedures in NYS hospitals were included in hospital-acquired infection program validation studies in 2009 and 2010. Medical chart reviews and on-site visits were performed to verify patient information reported and to evaluate additional risk factors for SSI. Bivariable and multivariable logistic regressions were performed.

Results

A total of 2,656 colon procedures were included in this analysis, including 698 SSI cases. Multivariable analysis indicated that SSI following colon procedure was associated with body mass index greater than 30 (odds ratio [OR], 1.48 [95% confidence interval (CI), 1.21–1.80]), male sex (OR, 1.34 [95% CI, 1.10–1.64]), American Society of Anesthesiologists physical classification score greater than 3 (OR, 1.33 [95% CI, 1.08–1.64]), procedure duration, transfusion (OR, 1.32 [95% CI, 1.05–1.66]), left-side colon surgical procedures, other gastroenterologic procedures, irrigation, hospital bed size greater than 500, and medical school affiliation.

Conclusions

Male sex, obesity, transfusion, type of procedure, and prolonged duration were significant factors associated with overall infection risk after adjusting other factors. Additional factors not collected in the NHSN slightly improved prediction of SSIs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 8 , August 2014 , pp. 1006 - 1012
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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

1. 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;32:970–986.CrossRefGoogle ScholarPubMed
2. Gaynes, RP, Culver, DH, Horan, TC, Edwards, JR, Richards, C, Tolson, JS. Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 2001;33(suppl 2):S69–S77.CrossRefGoogle ScholarPubMed
3. De Oliveira, AC, Ciosak, SI, Ferraz, EM, Grinbaum, RS. Surgical site infection in patients submitted to digestive surgery: risk prediction and the NNIS. Am J Infect Control 2006;34:201–207.CrossRefGoogle ScholarPubMed
4. Imai, E, Ueda, M, Kanao, K, et al. Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon, and gastric surgery. Am J Infect Control 2008;36:727–731.CrossRefGoogle ScholarPubMed
5. Neumayer, L, Hosokawa, P, Itani, K, El-Tamer, M, Henderson, WG, Khuri, SF. Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007;6:1178–1187.CrossRefGoogle Scholar
6. Tang, R, Chen, HH, Wang, YL, et al. Risk factors for surgical site infection after elective resection of colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg 2001;234(2):181–189.CrossRefGoogle Scholar
7. Haley, VB, Van Antwerpen, CL, Tserenpuntsag, B, et al. Use of administrative data in efficient auditing of hospital-acquired surgical site infections, New York State 2009–2010. Infect Control Hosp Epidemiol 2012;33(6):565–571.CrossRefGoogle ScholarPubMed
8. 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
9. Hanley, JA, McNeil, BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29–36.CrossRefGoogle Scholar
10. Hübner, M, Diana, M, Zanetti, G, Eisenring, MC, Demartines, N, Troillet, N. Surgical site infections in colon surgery: the patient, the procedure, the hospital, and the surgeon. Arch Surg 2011;146(11):1240–1245.CrossRefGoogle ScholarPubMed
11. Nystrom, AS, Jonstan, A, Hojer, H, Ling, I. Incisional infection after colorectal surgery in obese patients. Acta Chir Scand 1987;153:225–227.Google ScholarPubMed
12. Blumetti, J, Luu, M, Sarosi, G, et al. Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 2007;142:704–711.CrossRefGoogle ScholarPubMed
13. Walz, JM, Paterson, GA, Selligowski, JM, Heard, SO. Surgical site infection following bowel surgery, a retrospective analysis of 1446 patients. Arch Surg 2006;(141):1014–1018.CrossRefGoogle ScholarPubMed
14. Regenbogen, SE, Bordeianou, L, Hutter, MM, Gawande, AA. The intraoperative Surgical Apgar Score predicts postdischarge complications after colon and rectal resection. Surgery 2010;148:559–566.CrossRefGoogle ScholarPubMed
15. Kariv, Y, Wang, W, Senagore, AJ, et al. Multivariate analysis of factors associated with hospital readmission after intestinal surgery. Am J Surg 2006;191:364–374.CrossRefGoogle ScholarPubMed
16. Uchino, M, Ikeuchi, H, Tsuchida, T, Nakajima, K, Tomita, N, Takesue, Y. Surgical site infection following surgery for inflammatory bowel disease in patients with clean-contaminated wounds. World J Surg 2009;33(5):1042–1048.CrossRefGoogle ScholarPubMed
17. Alavi, K, Sturrock, PR, Sweeney, WB, et al. A simple risk score for predicting surgical site infections in inflammatory bowel disease. Dis Colon Rectum 2010;53(11):1480–1486.CrossRefGoogle ScholarPubMed
18. Esposito, S. Immune system and surgical site infection. J Chemother 2001;1:12–16.CrossRefGoogle Scholar
19. Cruse, PJ, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980:27–40.Google Scholar
20. Garibaldi, RA, Cushing, D, Lerer, T. Risk factors for postoperative infection. Am J Med 1991;91:158S–163S.CrossRefGoogle ScholarPubMed
21. Kaiser, AB, Herrington, JLJ, Jacobs, JK, et al. Cefoxitin versus erythromycin, neomycin, and cefazolin, in colorectal operations: importance of the duration of the surgical procedure. Ann Surg 1983;198:525–530.CrossRefGoogle ScholarPubMed
22. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class operative procedure, and patient risk index. Am I Med 1991;91:152S–157S.CrossRefGoogle ScholarPubMed
23. Degrate, L, Garancini, M, Misani, M, et al. Right colon, left colon, and rectal surgeries are not similar for surgical site infection development: analysis of 277 elective and urgent colorectal resections. Int J Colorectal Dis 2011;26:61–69.CrossRefGoogle Scholar
24. Shanahan, F. The host-microbe interface within the gut. Best Pract Res Clin Gastroenterol 2002;16:915–931.CrossRefGoogle ScholarPubMed
25. Parcells, JP, Mileski, JP, Gnagy, FT, Haragan, AF, Mileski, WJ. Using antimicrobial solution for irrigation in appendicitis to lower surgical site infection rates. Am J Surg 2009;198:875–880.CrossRefGoogle ScholarPubMed
26. Lord, JW, LaRaja, RD, Daliana, M, Gordon, M. Prophylactic antibiotic wound irrigation in gastric, biliary, and colonic surgery. Am J Surg 1983;145:209–212.CrossRefGoogle ScholarPubMed
27. Roth, RM, Gleckman, RA, Gantz, NM, Kelly, N. Antibiotic irrigations a plea for controlled clinical trials. Pharmacotherapy 1985;5:222–227.CrossRefGoogle ScholarPubMed
28. Brook, I, Frazier, E. Aerobic and anaerobic microbiology in intra-abdominal infections associated with diverticulitis. Clin Microbiol 2000;49:827–830.Google ScholarPubMed
29. Brook, I. A 12 year study of aerobic and anaerobic bacteria in intra-abdominal and postsurgical abdominal wound infections. Surg Gynecol Obstet 1989;169:387–392.Google ScholarPubMed