Nezar Jrebi, MD, Theodor Asgeirsson, MD, Rebecca E Hoedema, MD, Martin A Luchtefeld, MD, Donald G Kim, MD
Background: Organ space surgical site infections (SSIs) after colorectal resection is a well-recognized surgical complication with different treatment strategies based on presentation. This study tries to indentify patient specific factors of organ space SSIs treated with drain placement or observation.
Methods: A retrospective chart review was performed on patients who underwent elective colorectal resection between January 2008 and December 2011. We studied patients who developed organ space infections that could be managed non-operatively with drain placement or conservative management. We compared, co-morbidities, abscess size, duration of treatment and direct cost of care between the two groups. Statistical analysis was performed with Fischer’s Exact Test and Pearson Chi-Square.
Results: 1472 elective colorectal resections were performed during the timeframe. Organ space SSIs not requiring surgical intervention were identified in 88 (5.9%) patients. Among those 53 (60.2%) were managed with drain placement and 35 (39.7%) patients were treated conservatively. A fistula was detected in 28.3% (15 patients) of drain group and three patients required Tisseel injection for persistent fistula. The average size of abscesses among drain group and conservatively managed were 8.2 cm vs 2.4 cm (p < 0.0001), Duration of drain averaged 17.1 days (3 to 90 days). Four patients had recurrence within 20 days (3-42 days) with a mean abscess size of 6.2cm and required drain placement for 9.25 days (6-11 days). Six patients (11.3%) failed drain management and required surgical intervention.
There were no statistically significant differences between the two groups in term of age, BMI, hypertension, diabetes mellitus, coronary artery disease, hyperlipidemia, ulcerative colitis, COPD, smoking and postoperative complications. However, patients with Crohn’s disease (18.9% vs 2.9%; p < 0.026) were more likely to have drain placement.
There is a trend toward much less cost using drain vs observation, this is probably due to shorter length of stay and fewer radiological evaluations.
Conclusion: Organ space SSIs treated with radiologically placed drains are an effective and cost-efficient strategy. The overall cost is less than with conservative management. Catheter drainage appears to result in shorter length of stay and fewer radiologic evaluations. If technically feasible, the indications for catheter drainage of organ space infections could be extended to smaller fluid collections.
Session: Poster Presentation
Program Number: P121