Risk factors for surgical site infection after elective resection of the colon and rectum: A single-center prospective study of 2,809 consecutive patients

Objective To identify the risk factors for surgical site infection (SSI) in patients undergoing elective resection of the colon and rectum. Summary Background Data SSI causes a substantial number of deaths and complications. Determining ri sk factors for SSI may provide information on reducing complications and im proving outcome. Methods The authors performed a prospective study of 2,809 consecutive patients und ergoing 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 cl inical leakage, A likelihood ratio forward regression model was used to ass ess the independent association of variables with SSIs. Results The overall SSI, incisional SSI, and organ/space SSI with and without clini cal anastomotic leakage rates were 4.7%, 3%, 2%, and 0.8%, respectively. Ri sk factors for overall SSI were American Society of Anesthesiology (ASA) sc ore 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 po stoperative blood transfusion (1-3 units, OR = 5.3; greater than or equal t o4 units, OR = 6.2). However, SSIs at specific sites differed from each oth er 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 spe cific site. Conclusions In addition to ASA score and surgical wound class, blood transfusion, creat ion of ostomy, types of operation, use of drainage, sex, and surgeons were important in predicting SSIs after elective colorectal resection.