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Yu KY, Kuang RK, Wu PP, Qiang GH. Subcutaneous fat thickness and abdominal depth are risk factors for surgical site infection after gastric cancer surgery. World J Clin Cases 2023; 11:8013-8021. [DOI: 10.12998/wjcc.v11.i33.8013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/19/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common complications after gastric cancer (GC) surgery. The occurrence of SSI can lead to a prolonged postoperative hospital stay and increased medical expenses, and it can also affect postoperative rehabilitation and the quality of life of patients. Subcutaneous fat thickness (SFT) and abdominal depth (AD) can be used as predictors of SSI in patients undergoing radical resection of GC.
AIM To explore the potential relationship between SFT or AD and SSI in patients undergoing elective radical resection of GC.
METHODS Demographic, clinical, and pre- and intraoperative information of 355 patients who had undergone elective radical resection of GC were retrospectively collected from hospital electronic medical records. Univariate analysis was performed to screen out the significant parameters, which were subsequently analyzed using binary logistic regression and receiver-operating characteristic curve analysis.
RESULTS The prevalence of SSI was 11.27% (40/355). Multivariate analyses revealed that SFT [odds ratio (OR) = 1.150; 95% confidence interval (95%CI): 1.090–1.214; P < 0.001], AD (OR = 1.024; 95%CI: 1.009–1.040; P = 0.002), laparoscopic-assisted surgery (OR = 0.286; 95%CI: 0.030–0.797; P = 0.017), and operation time (OR = 1.008; 95%CI: 1.001–1.015; P = 0.030) were independently associated with the incidence of SSI after elective radical resection of GC. In addition, the product of SFT and AD was a better potential predictor of SSI in these patients than either SFT or AD alone.
CONCLUSION SFT and AD are independent risk factors and can be used as predictors of SSI in patients undergoing radical resection of GC.
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Affiliation(s)
- Kuan-Yong Yu
- Department of Gastrointestinal Surgery, Nanjing Jiangbei Hospital, Nanjing 210044, Jiangsu Province, China
| | - Rong-Kang Kuang
- Department of Gastrointestinal Surgery, Nanjing Jiangbei Hospital, Nanjing 210044, Jiangsu Province, China
| | - Ping-Ping Wu
- Department of Endocrinology, Nanjing Jiangbei Hospital, Nanjing 210044, Jiangsu Province, China
| | - Guang-Hui Qiang
- Department of Gastrointestinal Surgery, Nanjing Jiangbei Hospital, Nanjing 210044, Jiangsu Province, China
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Dahal S, Gyawali S, Neupane P, Neupane P, Hamal A, Verma R, Pachhai P, Khadka R, Karki B, Khatiwada RD, Kansakar PBS. Comparison of abdominal depth with subcutaneous fat thickness in predicting surgical site infection among patients undergoing hepatopancreatobiliary surgery: a prospective observational study. Ann Med Surg (Lond) 2023; 85:4720-4724. [PMID: 37811037 PMCID: PMC10552989 DOI: 10.1097/ms9.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/27/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Surgical site infection (SSI) is a significant cause of postoperative morbidity resulting in an increased hospital stay and cost. Various measures have been used to predict SSI such as subcutaneous fat thickness (SCFT) and abdominal depth (AD) in case of abdominal surgeries. The objective of the study was to compare SCFT with AD to predict SSI in HPB surgeries. Methods A prospective observational study was conducted from February 2020 to February 2021, which included 76 patients who underwent elective open hepatopancreatobiliary surgeries. SCFT and AD at the level of the umbilicus were measured preoperatively using the computed tomography abdomen. The occurrence of SSI was evaluated in correlation with SCFT and AD. SCFT and AD were compared using the receiver operating characteristic curve for prediction of SSI. Results Twenty-five (32.3%) patients who underwent elective HPB surgeries developed SSI. 72% of the SSI were superficial. In multivariate analysis, only SCFT was associated with SSI, which was statistically significant. It was compared with AD using the receiver operating characteristic curve where SCFT proved to be better at predicting SSI (AUC=0.884) with cut-off =2.13 cm, sensitivity 84%, and specificity 86%), compared to AD with an AUC of 0.449. Conclusion SSI is the common cause of increased morbidity following hepato-pancreato-biliary surgeries with risk factors including SCFT and AD. Approximately one-third of patient developed SSI, with most the common being superficial SSI. SCFT at the incision site was associated with an increased rate of SSI and the better predictor for SSI as compared with the AD.
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Affiliation(s)
- Suman Dahal
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Sushil Gyawali
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | | | | | - Aliza Hamal
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Rupesh Verma
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Prarthana Pachhai
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Rabi Khadka
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Badal Karki
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Raj D. Khatiwada
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Prasan B. S. Kansakar
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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Marzoug OA, Anees A, Malik EM. Assessment of risk factors associated with surgical site infection following abdominal surgery: a systematic review. BMJ Surg Interv Health Technol 2023; 5:e000182. [PMID: 37529828 PMCID: PMC10387634 DOI: 10.1136/bmjsit-2023-000182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 08/03/2023] Open
Abstract
Objective Surgical site infections (SSIs) are among the most common healthcare-associated infections occurring following 1%-3% of all surgical procedures. Their rates are the highest following abdominal surgery. They are still associated with increased morbidity and healthcare costs despite the advancement in the medical field. Many risk factors for SSIs following abdominal surgery have been identified. The aim of this study is to comprehensively assess these risk factors as published in peer-reviewed journals. Design A systematic review was conducted with accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Setting The databases for search were PubMed and Cochrane Library, in addition to reference lists. Studies were retrieved and assessed for their quality. Data were extracted in a designed form, and a stratified synthesis of data was conducted to report the significant risk factors. Participants Patients undergoing general abdominal surgery. Intervention The intervention of general abdominal surgery. Main outcome measures To identify and assess the risk factors for SSI following abdominal surgery. Results Literature search yielded 813 articles, and the final screening process identified 11 eligible studies. The total number of patients is 11 996. The rates of SSI ranged from 4.09% to 26.7%. Nine studies were assessed to be of high quality, the remaining two studies have moderate quality. Stratified synthesis of data was performed for risk factors using summary measures (OR/risk ratio, 95% CI, and p value). Male sex and increased body mass index (BMI) were identified as significant demographic risk factors, and long operative time was among the major significant procedure-related risk factors. Conclusions Male sex, increased BMI, diabetes, smoking, American Society of Anesthesiologists classification of >2, low albumin level, low haemoglobin level, preoperative hospital stay, long operative time, emergency procedure, open surgical approach, increased wound class, intraoperative blood loss, perioperative infection, perioperative blood transfusion, and use of drains are potential independent risk factors for SSI following abdominal surgery.
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Affiliation(s)
- Omer A Marzoug
- Department of Anatomy, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ahmed Anees
- Department of Anatomy, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Elfatih M Malik
- Department of Community Medicine, University of Khartoum, Khartoum, Sudan
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Hughes CML, Jeffers A, Sethuraman A, Klum M, Tan M, Tan V. The detection and prediction of surgical site infections using multi-modal sensors and machine learning: Results in an animal model. Front Med Technol 2023; 5:1111859. [PMID: 37138726 PMCID: PMC10150061 DOI: 10.3389/fmedt.2023.1111859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Surgical Site Infection (SSI) is a common healthcare-associated infection that imposes a considerable clinical and economic burden on healthcare systems. Advances in wearable sensors and digital technologies have unlocked the potential for the early detection and diagnosis of SSI, which can help reduce this healthcare burden and lower SSI-associated mortality rates. Methods In this study, we evaluated the ability of a multi-modal bio-signal system to predict current and developing superficial incisional infection in a porcine model infected with Methicillin Susceptible Staphylococcus Aureus (MSSA) using a bagged, stacked, and balanced ensemble logistic regression machine learning model. Results Results demonstrated that the expression levels of individual biomarkers (i.e., peri-wound tissue oxygen saturation, temperature, and bioimpedance) differed between non-infected and infected wounds across the study period, with cross-correlation analysis indicating that a change in bio-signal expression occurred 24 to 31 hours before this change was reflected by clinical wound scoring methods employed by trained veterinarians. Moreover, the multi-modal ensemble model indicated acceptable discriminability to detect the presence of a current superficial incisional SSI (AUC = 0.77), to predict an SSI 24 hours in advance of veterinarian-based SSI diagnosis (AUC = 0.80), and to predict an SSI 48 hours in advance of veterinarian-based SSI diagnosis (AUC = 0.74). Discussion In sum, the results of the current study indicate that non-invasive multi-modal sensor and signal analysis systems have the potential to detect and predict superficial incisional SSIs in porcine subjects under experimental conditions.
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Affiliation(s)
- Charmayne Mary Lee Hughes
- Health Equity Institute NeuroTech Laboratory, San Francisco State University, San Francisco, CA, United States
- Correspondence: Charmayne Mary Lee Hughes
| | | | | | - Michael Klum
- Crely Healthcare Pte. Limited, Singapore, Singapore
| | - Milly Tan
- Crely Healthcare Pte. Limited, Singapore, Singapore
| | - Valerie Tan
- Crely Healthcare Pte. Limited, Singapore, Singapore
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Zhang X, Yang Z, Meng C, Gao J, Liu Y, Shi B, Sun L, Wu G, Yao H, Zhang Z. Abdomen anatomic characteristics on CT scans as predictive markers for short-term complications following radical resection of colorectal cancer. Front Surg 2022; 9:899179. [PMID: 35923439 PMCID: PMC9339639 DOI: 10.3389/fsurg.2022.899179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundPrediction and management of short-term postoperative complications in patients with colorectal cancer are essential in postoperative rehabilitation. Through CT scan images, we can easily measure some parameters of abdomen anatomic characteristics. This study aimed to assess whether there is a relationship between the abdomen anatomic characteristics and short-term postoperative complications.Materials and methodsWe conducted a retrospective study. Eighty patients in each complication group and non-complication group were recruited with propensity score match. Demographics, perioperative laboratory results and surgical information were collected and compared between groups with univariate analysis. Significant elements were brought into subsequent logistic regression analysis and ROC analysis for further identification.ResultsUnivariate analysis showed that preoperative white blood cells, preoperative neutrophil counts, rectus abdominis thickness (RAT), subcutaneous fat thickness (SFT), and abdomen depth (AD) were significantly different between the complication group and non-complication group. Logistic regression analysis demonstrated that higher RAT (p = 0.002), SFT (p < 0.001) and AD (p < 0.001) independently predicted the incidence of short-term postoperative complications.ConclusionsIn this study on patients undergoing radical resection of colorectal cancer, abdomen anatomic characteristics including higher RAT, SFT and AD are associated with an increased risk of short-term postoperative complications.
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Affiliation(s)
| | | | | | | | | | | | | | - Guocong Wu
- Correspondence: Guocong Wu Hongwei Yao Zhongtao Zhang
| | - Hongwei Yao
- Correspondence: Guocong Wu Hongwei Yao Zhongtao Zhang
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Wang J, Lv W, Xu S, Yang C, Du B, Zhong Y, Shi F, Shan A. Intraoperative incision irrigation with high-volume saline reduces surgical site infection for abdominal infections. Front Surg 2022; 9:927896. [PMID: 35903254 PMCID: PMC9314743 DOI: 10.3389/fsurg.2022.927896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeSurgical site infection (SSI) remains one of the most common postoperative complications for patients with abdominal infections. This study aimed at investigating the effectiveness of high-volume normal saline (NS) irrigation in preventing postoperative SSI for patients with abdominal infections.MethodsIn this retrospective before-after clinical study, patients who underwent emergency laparotomy due to abdominal infections between Jan 2015 and Dec 2021 were included consecutively. A cohort of 207 patients with NS irrigation was compared to historical controls. A propensity score matching (PSM) with a 1:1 ratio was performed to reduce potential bias. The primary outcome was the 30-day SSI rate.ResultsIrrigation (n = 207) and control (n = 207) matched patients were statistically identical on baseline characteristics, perioperative, and intraoperative parameters. Irrigation patients had lower overall SSI rates (10.6% vs. 26.1%, p < 0.001), mainly due to reduction in superficial (4.3% vs. 17.9%) and deep (1.4% vs. 3.9%) SSIs, rather than space/organ SSIs (4.8% vs. 4.3%). Irrigation patients also had lower rates of incision seroma (4.8% vs. 11.6%, p = 0.012), shorter duration of antibiotics use (5.2 ± 1.7 d vs. 7.2 ± 2.0 d, p < 0.001), and unplanned readmission (1.0% vs. 8.7%, p < 0.001). Length of hospital stay showed a declining trend with irrigation intervention, while no significant difference was observed. Moreoever, logistic regression revealed that NS irrigationwas an independent protector against SSI (OR 0.309; 95% CI, 0.207–0.462; p < 0.001).ConclusionIntraoperative incision irrigation with high-volume NS is associated with a lower rate of SSI for patients with abdominal infections.
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Affiliation(s)
| | | | | | | | - Bo Du
- Correspondence: Aijun Shan Fei Shi Yuanbo Zhong Bo Du
| | - Yuanbo Zhong
- Correspondence: Aijun Shan Fei Shi Yuanbo Zhong Bo Du
| | - Fei Shi
- Correspondence: Aijun Shan Fei Shi Yuanbo Zhong Bo Du
| | - Aijun Shan
- Correspondence: Aijun Shan Fei Shi Yuanbo Zhong Bo Du
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Sun C, Gao H, Zhang Y, Pei L, Huang Y. Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer. Front Oncol 2021; 11:705335. [PMID: 34858805 PMCID: PMC8630667 DOI: 10.3389/fonc.2021.705335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background Organ/space surgical site infection (organ/space SSI) is a serious postoperative complication, closely related to a poor prognosis. Few studies have attempted to stratify the risk of organ/space SSI for patients with advanced digestive system cancer. This study aimed to identify a simple risk stratification for these patients based on perioperative factors. Methods The study was based on two randomized controlled trials (RCT) (NCT02715076, ChiCTR-IPR-17011099), including 839 patients undergoing elective radical resection of advanced digestive system cancer. The primary outcome was organ/space SSI within 30 days after surgery. Multivariable logistic regression model was used to identify risk factors. The risk of organ/space SSI stratified over those risk factors was compared using chi-square tests and the relative risk (RR) was estimated. Results Among the 839 patients, 51 developed organ/space SSI (6.1%) within 30 days after surgery. According to the multivariable logistic regression model, 3 procedure types, including gastrectomy (OR=8.22, 95% CI: 2.71-24.87, P<0.001), colorectal resection (OR=8.65, 95% CI: 3.13-23.85, P<0.001) and pancreatoduodenectomy (OR=7.72, 95% CI: 2.95-20.21, P<0.001), as well as anaesthesia time > 4 h (OR=2.38, 95% CI: 1.08-5.27, P=0.032) and prolonged ICU stay (OR=4.10, 95% CI: 1.67-10.10, P=0.002), were risk factors for postoperative organ/space SSI. The number of risk factors was significantly associated with an increased risk of organ/space SSI (P<0.001), which was 2.8% in patients with 0-1 risk factor (RR=0.20, 95% CI: 0.11-0.35), 13.0% in patients with 2 risk factors (RR=3.64, 95% CI: 2.14-6.20) and 35.7% in patients with 3 risk factors (RR=6.41, 95% CI: 3.01-13.65). Conclusion This study is a preliminary exploratory and provides a simple risk stratification to identify the risk of postoperative organ/space SSI for patients with advanced digestive system cancer. Further research is needed to validate and generalize the results in a wider population. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02715076; Chinese Clinical Trial Registry [https://www.chictr.org.cn/enindex.aspx], identifier ChiCTR-IPR-17011099.
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Affiliation(s)
- Chen Sun
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hui Gao
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Centre, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lijian Pei
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Outcomes Research Consortium, Cleveland, OH, United States
| | - Yuguang Huang
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Xu Z, Qu H, Kanani G, Guo Z, Ren Y, Chen X. Update on risk factors of surgical site infection in colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2020; 35:2147-2156. [PMID: 32748113 DOI: 10.1007/s00384-020-03706-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Surgical site infection (SSI) in colorectal cancer (CRC) has been a serious health care problem due to the delay of postoperative recovery. Our present study aimed to explore the risk factors for SSI in CRC patients. METHODOLOGY We have systematically searched these databases: PubMed, Cochrane Library, and EMBASE as of March 2020 for studies on risk factors associated with SSI. Two investigators independently conducted the quality assessment and data extraction. Related risk factors in the studies were recorded, and a meta-analysis was performed. RESULTS The search initially provided 2262 hits, 1913 studies were screened by two independent investigators. Finally, 15 studies were identified to be relevant for this meta-analysis. In total, 25 risk factors were eligible. Our meta-analysis indicated that eight factors (obesity, male sex, diabetes mellitus, ASA score ≥ 3, stoma creation, intraoperative complications, perioperative blood transfusion, and operation time ≥ 180 min) were significant risk factors for SSI, and one factor (laparoscopic procedure) was protective for SSI. CONCLUSIONS Effective interventions targeting the above factors may reduce the risk of developing postoperative SSI in CRC patients and improve the clinical outcome of patients. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Zhaohui Xu
- Dalian Medical University, Dalian, China
| | - Hui Qu
- Dalian Medical University, Dalian, China
| | | | - Zhong Guo
- Dalian Medical University, Dalian, China
| | - Yanying Ren
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China
| | - Xin Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China.
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Abstract
Background This study aimed to evaluate the clinicopathological factors associated with surgical site infection (SSI) and the prognostic impact on patients after colorectal cancer (CRC) resection surgery. Material/Methods This retrospective study evaluated the relationships between SSI and various clinicopathological factors and prognostic outcomes in 326 consecutive patients with CRC who underwent radical resection surgery at Wuhan Union Hospital during April 2015–May 2017. Results Among the 326 patients who underwent radical CRC resection surgery, 65 had SSIs, and the incidence rates of incisional and organ/space SSI were 16.0% and 12.9%, respectively. Open surgery, chronic obstructive pulmonary disease (COPD), and a previous abdominal surgical history were identified as risk factors for incisional SSI. During a median follow-up of 40 months (range: 5–62 months), neither simple incisional nor simple organ/space SSI alone significantly affected disease-free survival (DFS) or overall survival (OS), whereas combined incisional and organ/space SSI had a significant negative impact on both the 3-year DFS and OS (P<0.001). A multivariate analysis identified that age ≥60 years, lymph node involvement, tumor depth (T3–T4), and incisional and organ/space SSI were independent predictors of 3-year DFS and OS. In addition, adjuvant chemotherapy and a carbohydrate antigen-125 concentration ≥37 ng/ml were also independent predictors of OS. Conclusions We have identified several clinicopathological factors associated with SSI, and identified incisional and organ/space SSI is an independent prognostic factor after CRC resection. Assessing the SSI classification may help to predict the prognosis of these patients and determine further treatment options.
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Affiliation(s)
- Yu Tang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Ruizhi Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Wenchang Yang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Wei Li
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
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