Impact of procedure on the post-operative infection risk of patients after elective colon surgery

Abstract

Background: Post-operative infection impacts the quality of patient care, prolongs the length of hospital stay, and utilizes more health care resources. The purpose of this study was to compare the rates of surgical site infection among three major surgical procedures for treating patients with colon pathology.

Hypothesis: The location of colon resection impacts the post-operative infection rate.

Methods: A retrospective cohort study was conducted by using the 2006 Nationwide Inpatient Sample. Adult patients (age ≥18 yr) with colon diseases are the population of interest. The disease status and procedures were categorized according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Patients with a primary diagnosis of diverticulosis of the colon without hemorrhage (ICD-9-CM codes: 562.11 and 562.12) or malignant neoplasm of the colon (ICD-9-CM codes: 153.x, where x represents the possible digits within this ICD-9-CM code category), with procedures of open and other right hemicolectomy (ORH; ICD-9-CM code: 45.73) or open and other left hemicolectomy (OLH; ICD-9-CM code: 45.75), or open and other sigmoidectomy (OS; ICD-9-CM code: 45.76) were included for this study. The primary measured outcome for the study was surgical site infection.

Results: There were an estimated 26,381 ORH procedures, 9,558 OLH procedures, and 31,656 OS procedures performed in 2006. There was a significant difference among procedures with respect to their age distributions (mean [standard error]: ORH vs. OLH vs. OS=70.5 [0.2] vs. 63.8 [0.3] vs. 59.5 [0.2] yr, p<0.0001) and the gender distributions (female percentage ORH vs. OLH vs. OS=56.1% vs. 51.5% vs. 50.9%, p<0.0001). There was a significant difference among the surgical procedures (infection rates: ORH vs. OLH vs. OS=2.9% vs. 5.6% vs. 4.9%, p<0.0001). From a logistic regression model, after controlling for age, gender, primary diagnosis, comorbidities, and hospital teaching status, OLH had a higher chance of SSI (adjusted odds ratio [AOR] [95% confidence interval {CI}]=1.54 [1.16-2,05], p=0.003) compared with ORH. However, OS did not have different SSI rates (AOR [95% CI]=1.18 [0.90-1.54], p=0.234) compared with ORH. There was a higher rate of infection for OLH (AOR [95% CI]: 1.31 [1.04-1.64], p=0.02) compared with OS.

Conclusions: Different sites of colon operations were associated with different risks of surgical site infections. Accordingly, appropriate pre-operative measures should address these differences.