Surgical Site Infection Impact of Pelvic Exenteration Procedure

Zhobin Moghadamyeghaneh, MD, Alessio Pigazzi, MD, Michael J Stamos, MD. University of California, Irvine

Background and hypothesis

There is limited data available on the surgical site infection (SSI) of patients following debulking operation of pelvic exenteration. NHSN includes these patients under the broad category of colectomy. We sought to compare surgical site infection in patients with pelvic exenteration procedure and conventional rectal resections.

Design and methods

The NSQIP databases were used to examine the clinical data of rectal cancer patients undergoing elective resection between 2010 and 2012 with wound class 2 (clean contaminated). We separated the patients into two groups of underwent pelvic exenteration and conventional proctectomy resections. Multivariate regression analysis with adjustment of the results with demographic factors and 15 preoperative comorbid conditions was performed in comparing surgical site infection complications.

Results

We sampled a total of 1,536 patients who underwent rectal resection. Of these, 229 (14.9%) patients underwent pelvic exenteration. In multivariate analysis after adjustment patients who underwent pelvic exenteration had more than two times higher rates of organ space SSI (AOR: 2.08, P<0.05) and superficial SSI (AOR: 2.08, P= P<0.05). Also, postoperative sepsis (AOR: 2.57, P<0.05) and septic shock (AOR: 3.82, P<0.05) were higher in patients who underwent pelvic exenteration.

Conclusion

Patients undergoing pelvic exenteration have more than twice rates of organ space and superficial surgical site infections compared to conventional rectal resections. Also, they have increased risk of postoperative sepsis and septic shock complications. Specific consideration to infectious complications is recommended for these patients.

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