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Risk of Surgical Site Infection (SSI) following Colorectal Resection Is Higher in Patients With Disseminated Cancer: An NCCN Member Cohort Study

Published online by Cambridge University Press:  19 March 2018

Mini Kamboj ,
Teresa Childers ,
Jessica Sugalski ,
Donna Antonelli ,
Juliane Bingener-Casey ,
Jamie Cannon ,
Karie Cluff ,
Kimberly A. Davis ,
E. Patchen Dellinger  and
Sean C. Dowdy
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Mini Kamboj*
Affiliation:
Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York
Teresa Childers
Affiliation:
Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York
Jessica Sugalski
Affiliation:
National Comprehensive Cancer Network, Fort Washington, Pennsylvania
Donna Antonelli
Affiliation:
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
Juliane Bingener-Casey
Affiliation:
Department of Surgery, Mayo Clinic, Rochester, Minnesota
Jamie Cannon
Affiliation:
University of Alabama at Birmingham Medicine, Birmingham, Alabama
Karie Cluff
Affiliation:
University of Utah Medical Center, Salt Lake City, Utah
Kimberly A. Davis
Affiliation:
Surgery, Yale University School of Medicine, New Haven, Connecticut
E. Patchen Dellinger
Affiliation:
Department of Surgery, University of Washington, Seattle, Washington
Sean C. Dowdy
Affiliation:
Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota
Kim Duncan
Affiliation:
University of Nebraska Medical Center, Omaha, Nebraska
Julie Fedderson
Affiliation:
University of Nebraska Medical Center, Omaha, Nebraska
Robert Glasgow
Affiliation:
Department of Surgery, University of Utah Medical Center, Salt Lake City, Utah
Bruce Hall
Affiliation:
Barnes-Jewish Hospital, Washington University, St Louis, Missouri
Marilyn Hirsch
Affiliation:
Yale-New Haven Hospital, New Haven, Connecticut
Matthew Hutter
Affiliation:
General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts
Lisa Kimbro
Affiliation:
National Comprehensive Cancer Network, Fort Washington, Pennsylvania
Boris Kuvshinoff II
Affiliation:
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
Martin Makary
Affiliation:
Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland
Melanie Morris
Affiliation:
University of Alabama at Birmingham Medicine, Birmingham, Alabama
Sharon Nehring
Affiliation:
Surgery Clinical Research Office, Mayo Clinic, Rochester, Minnesota
Sonia Ramamoorthy
Affiliation:
University of California, San Diego Health System, San Diego, California
Rebekah Scott
Affiliation:
University of California, San Diego Health System, San Diego, California
Mindy Sovel
Affiliation:
Memorial Sloan Kettering, New York, New York
Vivian Strong
Affiliation:
Memorial Sloan Kettering, New York, New York
Ashley Webster
Affiliation:
Quality Improvement, University of Alabama Birmingham Hospital, Birmingham, Alabama
Elizabeth Wick
Affiliation:
Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland
Julio Garcia Aguilar
Affiliation:
Memorial Sloan Kettering, New York, New York
Robert Carlson
Affiliation:
National Comprehensive Cancer Network, Fort Washington, Pennsylvania
Kent Sepkowitz
Affiliation:
Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York Department of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence to Mini Kamboj, MD, 1275 York Avenue, New York, NY 10065 (kambojm@mskcc.org).
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Abstract

BACKGROUND

Surgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.

OBJECTIVE

To examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRS

DESIGN

American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011–2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.

SETTING

Multicenter study

PARTICIPANTS

Of 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

MAIN OUTCOME

The primary outcome of interest was 30-day SSI rate.

RESULTS

A total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23–2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09–1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06–2.53; P=.02), and longer duration of procedure were associated with development of SSI.

CONCLUSIONS

Patients with disseminated cancer are at a higher risk for developing SSI. ASA score >3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.

Infect Control Hosp Epidemiol 2018;39:555–562

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 555 - 562
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors of equal contribution.

References

REFERENCES

1. Key statistics for colorectal cancer. American Cancer Society website. http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics. Accessed November 20, 2016.Google Scholar
2. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle ScholarPubMed
3. Anderson, DJ, Kaye, KS, Classen, D, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(Suppl 1):S51–S61.CrossRefGoogle ScholarPubMed
4. Malone, DL, Genuit, T, Tracy, JK, Gannon, C, Napolitano, LM. Surgical site infections: reanalysis of risk factors. J Surg Res 2002;103:89–95.Google Scholar
5. Anderson, DJ, Podgorny, K, Berrios-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605–627.Google Scholar
6. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
7. Tang, R, Chen, HH, Wang, YL, et al. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg 2001;234:181–189.CrossRefGoogle Scholar
8. Ju, MH, Ko, CY, Hall, BL, Bosk, CL, Bilimoria, KY, Wick, EC. A comparison of 2 surgical site infection monitoring systems. JAMA Surg 2015;150:51–57.Google Scholar
9. Serra-Aracil, X, Garcia-Domingo, MI, Pares, D, et al. Surgical site infection in elective operations for colorectal cancer after the application of preventive measures. Arch Surg 2001;146:606–612.CrossRefGoogle Scholar
10. Khuri, SF, Daley, J, Henderson, W, et al. The Department of Veterans Affairs NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 1998;228:491–507.Google Scholar
11. Cohen, ME, Ko, CY, Bilimoria, KY, et al. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 2013;217:336–346.Google Scholar
12. Henderson, WG, Daley, J. Design and statistical methodology of the National Surgical Quality Improvement Program: Why is it what it is? Am J Surg 2009;198:S19–S27.CrossRefGoogle ScholarPubMed
13. Data collection, analysis, and reporting. American Cancer Society NSQIP website. https://www.facs.org/quality-programs/acs-nsqip/program-specifics/data. Accessed July 25, 2016.Google Scholar
14. Healthcare-associated infections. Medicare.gov website. https://www.medicare.gov/hospitalcompare/Data/Healthcare-Associated-Infections.html. Accessed July 25, 2016.Google Scholar
15. Mu, Y, Edwards, JR, Horan, TC, Berrios-Torres, SI, Fridkin, SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol 2011;32:970–986.Google Scholar
16. Bot, J, Piessen, G, Robb, WB, Roger, V, Mariette, C. Advanced tumor stage is an independent risk factor of postoperative infectious complications after colorectal surgery: arguments from a case-matched series. Dis Colon Rectum 2013;56:568–576.CrossRefGoogle ScholarPubMed
17. Segal, CG, Waller, DK, Tilley, B, Piller, L, Bilimoria, K. An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery. Surgery 2014;156:1253–1260.CrossRefGoogle ScholarPubMed
18. Reducing colorectal surgical site infections. Joint Commission Center for Transforming Health Care website. https://www.centerfortransforminghealthcare.org/assets/4/6/SSI_storyboard.pdf. Published 2014. Accessed February 9, 2018.Google Scholar
19. Sehgal, R, Berg, A, Figueroa, R, et al. Risk factors for surgical site infections after colorectal resection in diabetic patients. J Am Coll Surg 2011;212:29–34.CrossRefGoogle ScholarPubMed
20. Kwon, S, Thompson, R, Dellinger, P, Yanez, D, Farrohki, E, Flum, D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg 2013;257:8–14.CrossRefGoogle ScholarPubMed
21. Pomposelli, JJ, Baxter, JK 3d, Babineau, TJ, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. J Parenter Enteral Nutr 1998;22:77–81.Google Scholar
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