Risk of Surgical Site Infection Varies Based on Location of Disease and Segment of Colorectal Resection for Cancer

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Abstract

BACKGROUND:

Current quality-monitoring initiatives do not accurately evaluate surgical site infections based on type of surgical procedure.

OBJECTIVE:

This study aimed to characterize the effect of the anatomical site resected (right, left, rectal) on wound complications, including superficial, deep, and organ space surgical site infections, in patients who have cancer.

SETTINGS:

Data were retrieved from the American College of Surgeons National Surgical Quality Improvement Program database.

DESIGN:

This study was designed to determine the independent risk associated with the anatomical location of cancer resection for all subtypes of surgical site infection. Statistical methods included the Fisher exact test, the χ2 test, and univariable and multivariable analyses for each outcome of interest.

PATIENTS:

All colon and rectal resections for colorectal cancer between 2006 and 2012 were selected. Included were 45,956 patients: 17,993 (39.2%) underwent right colectomy, 11,538 (25.1%) underwent left colectomy, and 16,425 (35.7%) underwent rectal resections.

RESULTS:

The overall surgical site infection rate was 12.3%: 3.7% organ space, 1.4% deep, and 7.2% superficial. On multivariable analysis, rectal resection was associated with the greatest odds of overall surgical site infections in comparison with left- or right-sided resections (rectal OR, 1.51; 95% CI, 1.35–1.69 vs left OR, 1.09; 95% CI, 0.97–1.23 vs right OR, 1). Rectal resections were also associated with greater odds of developing a deep surgical site infection than either right (rectal OR, 1.45; 95% CI, 1.06–1.99) or left (OR, 0.89; 95% CI, 0.62–1.27). The likelihood of organ space surgical site infection followed a similar pattern (rectal OR, 1.83; 95% CI 1.49–2.25; left colon, OR, 0.95; 95% CI, 0.75–1.19). Rectal and left resections had increased odds of superficial surgical site infections compared with right resections (rectal OR, 1.31; 95% CI, 1.14–1.51; left OR, 1.19; 95% CI, 1.03–1.37).

LIMITATIONS:

This is a retrospective observational study.

CONCLUSIONS:

Rectal resections for cancer are independently associated with an increased likelihood of superficial, deep, and organ space infections. The policy on surgical site infections as a quality measure currently in place requires modification to adjust for the location of pathology and, hence, the anatomical segment resected when assessing the risk for type of surgical site infection.

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