Risk factors of surgical site infection after hepatectomy for liver cancers.
ABSTRACT Risk factors of surgical site infection (SSI) after hepatectomy under the guideline of Centers for Disease Control and Prevention (CDC) are not well examined.
Hospital records of consecutive patients who underwent hepatectomy without biliary reconstruction for liver cancers were reviewed retrospectively. Prophylactic antibiotics were given to patients just before skin incision and every 3 hours during the operations. Clinicopathological factors were compared between patients who developed SSI and those without it.
There were 405 patients identified, and the incidence of SSI was 23 cases (5.8%). In multivariate analysis, intraoperative bowel injury, blood loss >2000 ml, and age older than 65 years were significant risk factors of SSI after hepatectomy.
Prophylactic antibiotics were necessary only during the operation for most patients who underwent hepatectomy without biliary reconstruction. However, patients with intraoperative bowel injury, blood loss >2000 ml, and age older than 65 years are at risk to develop SSI and might need additional administration of prophylactic antibiotics after surgery.
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ABSTRACT: To identify the risk factors for surgical site infection (SSI) in patients undergoing elective resection of the colon and rectum. SSI causes a substantial number of deaths and complications. Determining risk factors for SSI may provide information on reducing complications and improving outcome. The authors performed a prospective study of 2,809 consecutive patients undergoing elective colorectal resection via laparotomy between February 1995 and December 1998 at a single institution. The outcome of interest was SSI, which was classified as being incisional or organ/space with or without clinical leakage. A likelihood ratio forward regression model was used to assess the independent association of variables with SSIs. The overall SSI, incisional SSI, and organ/space SSI with and without clinical anastomotic leakage rates were 4.7%, 3%, 2%, and 0.8%, respectively. Risk factors for overall SSI were American Society of Anesthesiology (ASA) score 2 or 3 (odd ratio [OR] = 1.7), male gender (OR = 1.5), surgeons (OR = 1.3-3.3), types of operation (OR = 0.3-2.1), creation of ostomy (OR = 2.1), contaminated wound (OR = 2.9), use of drainage (OR = 1.6), and intra- or postoperative blood transfusion (1-3 units, OR = 5.3; >/=4 units, OR = 6.2). However, SSIs at specific sites differed from each other with respect to the risk factors. Among a variety of risk factors, only blood transfusion was consistently associated with a risk of SSI at any specific site. In addition to ASA score and surgical wound class, blood transfusion, creation of ostomy, types of operation, use of drainage, sex, and surgeons were important in predicting SSIs after elective colorectal resection.Annals of Surgery 08/2001; 234(2):181-9. · 6.33 Impact Factor
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ABSTRACT: Despite evidence supporting short antibiotic prophylaxis (ABP), it is still common practice to continue ABP for more than 48 hours after coronary artery bypass graft (CABG) surgery. To compare the effect of short (<48 hours) versus prolonged (>48 hours) ABP on surgical site infections (SSIs) and acquired antimicrobial resistance, we conducted an observational 4-year cohort study at a tertiary-care center. An experienced infection control nurse performed prospective surveillance of 2641 patients undergoing CABG surgery. The main exposure was the duration of ABP, and main outcomes were the adjusted rate of SSI and the isolation of cephalosporin-resistant enterobacteriaceae and vancomycin-resistant enterococci (acquired antibiotic resistance). Adjustment for confounding was performed by multivariable modeling. A total of 231 SSIs (8.7%) occurred after a median of 16 days, including 93 chest-wound infections (3.5%) and 13 deep-organ-space infections (0. 5%). After 1502 procedures using short ABP, 131 SSIs were recorded, compared with 100 SSIs after 1139 operations with prolonged ABP (crude OR, 1.0; CI, 0.8 to 1.3). After adjustment for possible confounding, prolonged ABP was not associated with a decreased risk of SSI (adjusted OR, 1.2; CI, 0.8 to 1.6) and was correlated with an increased risk of acquired antibiotic resistance (adjusted OR, 1.6; CI, 1.1 to 2.6). Our findings confirm that continuing ABP beyond 48 hours after CABG surgery is still widespread; however, this practice is ineffective in reducing SSI, increases antimicrobial resistance, and should therefore be avoided.Circulation 06/2000; 101(25):2916-21. · 15.20 Impact Factor
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ABSTRACT: Many observational studies have described an association between perioperative transfusion and postoperative infection. Detection of such a relationship may depend on which variables are considered as potential confounders of the association under study. However, most reports have not considered risk factors for postoperative infection at specific sites as possible explanations for the observed relationship. The records of 492 patients undergoing elective colorectal cancer resection at the Massachusetts General Hospital between January 1992 and December 1994 were reviewed. The probability of infection in association with transfusion was calculated with and without adjustment for the effects of chronic systemic illness, number of days with urinary catheter, endotracheal intubation, impaired consciousness, and specific risk factors for wound infection. Postoperative infection at any site and infections at specific sites were analyzed as separate outcomes. After adjustment for the effects of the variables listed above, allogeneic transfusion was not associated with postoperative infection at any site (p = 0.407). Only a specific association of transfusion with wound infection could be detected. However, in an analysis that adjusted for the effects of only the 18 confounders considered by previous authors, transfusion was the most significant predictor of infection. In that analysis, the risk of postoperative infection increased by 14 percent per unit of red cells transfused (p < 0.001). The overall adverse relationship between transfusion and infection reported by previous observational studies may have been due to an incomplete consideration of the variables that confound that association. This finding may help explain the disagreement between the conclusions of recent large, randomized, controlled trials (which failed to detect a deleterious transfusion effect) and the earlier observational studies.Transfusion 01/1996; 36(11-12):1000-8. · 3.53 Impact Factor