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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*
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).

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
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors of equal contribution.

References

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Supplementary material: File

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