Surgical Site Infections After Colorectal surgeries: A risk that can be decreased

Abdelrahman Attili, MD¹, Danielle Craigg², Anthony Dinallo², Megan Navarro², Janelle Spence¹, Haane Massarotti², Allen Chudzinski². ¹University of Central Florida, ²Florida Hospital Tampa

Introduction: Surgical site infections (SSI) are considered a major cause of morbidity and an independent predictor for mortality in surgical patients. It accounts for approximately a quarter of all nosocomial infections and it contributes to increase length of hospital stay along with increased cost of health care up to $ 15,000 per case. Colorectal surgery is considered to be associated with higher rates of SSI compared to other surgeries. In this study we compared our SSI rate to the National Surgical Quality Improvement Program (NSQIP) predicted rate after using our adopted protocol for colorectal bundle .

Methods: With institutional review board approval, all patients undergoing colorectal resections in our institution between 2016-2018 were prospectively followed. We have adopted a specific protocol which was applied to all of our patients that includes, precise enhanced recovery after surgery, mechanical and antibiotic bowl preperation, perioperative antibiotics, specific intraoperative scrubbing technique using alcohol and chlorhexidine, wound irrigation , the use of a wound protector, and the application of negative pressure wound vacuum followed by post operative wound monitoring. Patients demographic data, risk factors for SSI, and perioperative outcomes including SSI rate were collected and analyzed. Data is presented as median (mean ± SD).

Results: A total of 163 patients underwent colorectal resections within the study period. Fifty four percent had robotic approach, twenty two percent had laparoscopic approach, while twenty four percent had open approach. Age was 60.5 (59.8 ± 14.15), 54.6 % were men, body mass index of 26.4 (27.22 ± 5.59) kg/m2, 46 % were smokers, and 12.4 % were diabetic [Table 1]. Four patients had SSIs (2.4 %) which was statistically different from the predicted NSQIP outcome of 7.4% for these patients (p=0.029) [ Table 2]. One patient had superficial wound infection that was treated with antibiotics, another three patients had deep wound infections manifested by anastomotic leak.

Conclusion: Our results suggests that using this specific protocol will help to substantially decrease the rate of SSI after colorectal surgeries compared to the predicted NSQIP SSI rate for these patients. This protocol is safe and simple, and may reduce the post operative morbidity after colorectal surgeries.