Surgical site infection after colorectal cancer surgery in Maiduguri, north-eastern Nigeria
DOI:
https://doi.org/10.18203/2349-2902.isj20162783Keywords:
Surgical site infection, Colorectal cancer, Colorectal surgery, Risk factorsAbstract
Background: Colorectal surgery is associated with high rates of surgical site infection (SSI). Determining risk factors for SSI may provide information on reducing complications and improving outcome. The aim of this study was to determine the incidence of SSIs in colorectal cancer patients who had colorectal surgery in our centre, and to identify the risk factors for developing SSIs in these patients.
Methods: This was a retrospective study of patients who had open colorectal surgery for colorectal cancer over a twelve-year period (2000 to 2012) at the University of Maiduguri Teaching Hospital, Nigeria. SSI included incisional SSI and organ/space SSI within thirty days of the surgery.
Results: A total of 56 patient records were analyzed. An infection rate of 33.9% was documented; all 19 infections were incisional SSIs, occurring after surgery involving the rectum and anus. The perineal incision site was involved in 63.2%, of which 75% were superficial. Wound dehiscence occurred in 26.3%. Risk factors identified to be associated with SSIs include pre-operative bowel preparation, peri-operative blood transfusion, stoma creation, tumour location and the type of operation.
Conclusions: The rate of SSIs following oncologic colorectal surgery in our centre is high at 33.9%. All the SSIs were incisional, involving surgery of the rectum and anus. The tumour site, type of operation, stoma creation, mechanical bowel preparation and blood transfusion were identified to be associated with SSIs.References
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention for surgical site infection, 1999: hospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1999;20:250-78.
Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection, results of prospective surveillance. Ann Surg. 2006;244(5):756-63.
Murray BW, Huerta S, Dineen S, Anthony T. Surgical site infection in colorectal surgery: a review of the non-pharmacologic tools of prevention. J Am Coll Surg. 2010;211(6):812-22.
Smith RL, Bohl JK, Mcelearney ST, Friel CM, Barclay MM, Sawyer RG et al. Wound Infection After Elective Colorectal Resection. Ann Surg. 2004;239(5):599-607.
Biffi R, Fattori L, Bertani E, Radice D, Rotmensz N, Misitano P et al. Surgical site infections following colorectal cancer surgery: a randomized prospective trial comparing common and advanced anti-microbial dressing containing ionic silver. Worl J Surg Oncol. 2012;10:94.
Wax DB, Schaner D, Hossain S, Bodian CA, Reich DL, Beilin Y. Intraoperative factors associated with development of surgical site infection after colorectal surgery. Internet J Anasthaesiology. 2009;20(1):1-5.
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(10):606-8.
Mofikoya BO, Niemogha MT, Ogunsola FT, Ayotebi OA. Predictors of surgical site infections of the abdomen in Lagos, Nigeria. Nig Q J Hosp Med. 2011;21(2):124-8.
Ukwenya YA, Ahmed A. Surgical site infection following colorectal cancer surgery: observations from Zaria, Northern Nigeria. Arch Int Surg. 2013;3:92-6.
Aracil SX, Domingo GMI, Pares D, Basany EE, Biondo S, Guirao X, et al. Surgical site infection in elective operations for colorectal cancer after the application of preventive measures. Arch Surg. 2011;146(5):606-12.
Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC et al. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-centre prospective study of 2,809 consecutive patients. Ann Surg. 2001;234(2):181-9.
Biondo S, Kreisler E, Fraccalvieri D, Bassany EE, Codina CA, Ortiz H. Risk factors for surgical site infection after elective resection for rectal cancer. a multivariate analysis on 2131 patients. Colorectal Dis. 2012;14(3):102.
Pendlimari R, Cima RR, Wolff BG, Pemberton JH, Huebner M. Diagnoses influence surgical site infections (SSI) in colorectal surgery: a must consideration for SSI reporting programs? J Am Coll Surg. 2012;214(4):574-80.
Jimenez JC, Wilson SE. Prophylaxis of infection for elective colorectal surgery. Surg Infect. 2003;4(3):273-80.
Jensen LS, Kissmeyer NP, Wolff B, Ovist N. Randomized comparison of leucocyte-depleted versus buffy coat-poor blood transfusion and complications after colorectal surgery. Lancet. 1996;348(9031):841-5.
Blumetti J, Luu M, Sarosi G, Hartless K, Mcfarlin J, Parker B, et al. Surgical site infections after colorectal surgery: do risk factors vary depending on the type of Infection considered? Surgery. 2007;142(5):704-11.
Mahmoud NN, Turpin RS, Yang G, Saunders WB. Impact of surgical site infections on length of hospital stay and costs in selected colorectal procedures. Surg Infect. 2009;10(6):539-44.
Microbiology of surgical site infection (SSI) in patients undergoing stoma reversal. Available at www.archive-org-2013.com>ORG>S>SISNA. Accessed on 14 April 2016.
Contant CM, Hop WC, Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP et al, Mechanical bowel preparation for elective colorectal surgery: a multicentre randomized trial. Lancet. 2007;370(9605):2112-7.
Lohsiriwat V, Lohsiriwat D. Antibiotic prophylaxis and incisional surgical site infection following colorectal cancer surgery: an analysis of 330 cases. J Med Assoc Thai. 2009;92(1):12-6.
Kobayashi M, Mohri Y, Tonouchi H, Miki C, Nakai K, Kusunoki M. On behalf of the mie surgical infection research group. randomized clinical trial comparing intravenous antimicrobial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of surgical site infection in colorectal cancer surgery. Surg Today. 2007;37(5):383-8.
Cima R, Dankbar E, Lovely J, Pendlimari R, Aronhalt K, Nehring S, et al. Colorectal surgery surgical site infection reduction program: a national surgical quality improvement program-driven multidisciplinary single-institution experience. J Am Coll Surg. 2013;216(1):23-33.
Monn MF, Haut ER, Lau BD, Streiff M, Wick EC, Efron JE, et al. Is venous thromboembolism in colorectal surgery patients preventable or inevitable? one institution’s experience. J Am Coll Surg. 2013;216(3):395-401.
