The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery

Bryce W. Murray, Daisha J. Cipher, Thai Pham, Thomas Anthony

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Introduction: The purpose of this study was to evaluate the long-term complications of surgical site infection (SSI) in the colorectal population, specifically its association with incisional hernia and small bowel obstruction. Methods: Using standardized definitions of SSI, a retrospective review of patients undergoing transabdominal colorectal surgery from January 2002 to December 2005 was performed. Primary outcomes included incisional hernia and small bowel obstruction in patients with SSIs. Results: A total of 443 patients were analyzed. The median surgical follow-up was 12 months (23,091 days). Infections were identified in 101 (23%) cases. There were 99 cases (22%) of incisional hernia and 32 cases (7%) of small bowel obstruction. Logistic regression revealed SSI to be independently associated with incisional hernia after adjusting for clinical covariates (adjusted odds ratio = 2.23, P =.003; 95% confidence interval, 1.33.8). Patients with incisional hernia were 1.9 times more likely to have had an SSI (36.3% vs 18.8%, P ≤.01). They required a longer operative time (224 minutes vs 198 minutes, P =.03), had an increased body mass index (29.0 vs 26.8, P ≤.01), and had increased estimated blood loss (363 vs 289, mL, P =.03). Small bowel obstruction was significantly associated with operations involving the rectum (11.5% in operations involving the rectum vs 5.9% in nonrectal operations, P =.05), increased estimated blood loss (409 ml vs 297 ml, P =.04), and red blood cell transfusion (15.5% with transfusion vs 5.7% without, P =.01). SSI was not an independent predictor of small bowel obstruction (adjusted odds ratio = 1.05, P =.91; 95% confidence interval,.452.5). Conclusions: Patients with an SSI were 1.9 times more likely to have an incisional hernia than those without an SSI. An SSI after colorectal surgery was a risk factor for the development of incisional hernia but was not a risk factor for small bowel obstruction in our population.

Original languageEnglish (US)
Pages (from-to)558-560
Number of pages3
JournalAmerican Journal of Surgery
Volume202
Issue number5
DOIs
StatePublished - Nov 2011

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Surgical Wound Infection
Colorectal Surgery
Rectum
Odds Ratio
Confidence Intervals
Erythrocyte Transfusion
Incisional Hernia
Operative Time
Population
Body Mass Index
Logistic Models

Keywords

  • Incisional hernia
  • Small bowel obstruction
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery

Cite this

The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. / Murray, Bryce W.; Cipher, Daisha J.; Pham, Thai; Anthony, Thomas.

In: American Journal of Surgery, Vol. 202, No. 5, 11.2011, p. 558-560.

Research output: Contribution to journalArticle

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abstract = "Introduction: The purpose of this study was to evaluate the long-term complications of surgical site infection (SSI) in the colorectal population, specifically its association with incisional hernia and small bowel obstruction. Methods: Using standardized definitions of SSI, a retrospective review of patients undergoing transabdominal colorectal surgery from January 2002 to December 2005 was performed. Primary outcomes included incisional hernia and small bowel obstruction in patients with SSIs. Results: A total of 443 patients were analyzed. The median surgical follow-up was 12 months (23,091 days). Infections were identified in 101 (23{\%}) cases. There were 99 cases (22{\%}) of incisional hernia and 32 cases (7{\%}) of small bowel obstruction. Logistic regression revealed SSI to be independently associated with incisional hernia after adjusting for clinical covariates (adjusted odds ratio = 2.23, P =.003; 95{\%} confidence interval, 1.33.8). Patients with incisional hernia were 1.9 times more likely to have had an SSI (36.3{\%} vs 18.8{\%}, P ≤.01). They required a longer operative time (224 minutes vs 198 minutes, P =.03), had an increased body mass index (29.0 vs 26.8, P ≤.01), and had increased estimated blood loss (363 vs 289, mL, P =.03). Small bowel obstruction was significantly associated with operations involving the rectum (11.5{\%} in operations involving the rectum vs 5.9{\%} in nonrectal operations, P =.05), increased estimated blood loss (409 ml vs 297 ml, P =.04), and red blood cell transfusion (15.5{\%} with transfusion vs 5.7{\%} without, P =.01). SSI was not an independent predictor of small bowel obstruction (adjusted odds ratio = 1.05, P =.91; 95{\%} confidence interval,.452.5). Conclusions: Patients with an SSI were 1.9 times more likely to have an incisional hernia than those without an SSI. An SSI after colorectal surgery was a risk factor for the development of incisional hernia but was not a risk factor for small bowel obstruction in our population.",
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N2 - Introduction: The purpose of this study was to evaluate the long-term complications of surgical site infection (SSI) in the colorectal population, specifically its association with incisional hernia and small bowel obstruction. Methods: Using standardized definitions of SSI, a retrospective review of patients undergoing transabdominal colorectal surgery from January 2002 to December 2005 was performed. Primary outcomes included incisional hernia and small bowel obstruction in patients with SSIs. Results: A total of 443 patients were analyzed. The median surgical follow-up was 12 months (23,091 days). Infections were identified in 101 (23%) cases. There were 99 cases (22%) of incisional hernia and 32 cases (7%) of small bowel obstruction. Logistic regression revealed SSI to be independently associated with incisional hernia after adjusting for clinical covariates (adjusted odds ratio = 2.23, P =.003; 95% confidence interval, 1.33.8). Patients with incisional hernia were 1.9 times more likely to have had an SSI (36.3% vs 18.8%, P ≤.01). They required a longer operative time (224 minutes vs 198 minutes, P =.03), had an increased body mass index (29.0 vs 26.8, P ≤.01), and had increased estimated blood loss (363 vs 289, mL, P =.03). Small bowel obstruction was significantly associated with operations involving the rectum (11.5% in operations involving the rectum vs 5.9% in nonrectal operations, P =.05), increased estimated blood loss (409 ml vs 297 ml, P =.04), and red blood cell transfusion (15.5% with transfusion vs 5.7% without, P =.01). SSI was not an independent predictor of small bowel obstruction (adjusted odds ratio = 1.05, P =.91; 95% confidence interval,.452.5). Conclusions: Patients with an SSI were 1.9 times more likely to have an incisional hernia than those without an SSI. An SSI after colorectal surgery was a risk factor for the development of incisional hernia but was not a risk factor for small bowel obstruction in our population.

AB - Introduction: The purpose of this study was to evaluate the long-term complications of surgical site infection (SSI) in the colorectal population, specifically its association with incisional hernia and small bowel obstruction. Methods: Using standardized definitions of SSI, a retrospective review of patients undergoing transabdominal colorectal surgery from January 2002 to December 2005 was performed. Primary outcomes included incisional hernia and small bowel obstruction in patients with SSIs. Results: A total of 443 patients were analyzed. The median surgical follow-up was 12 months (23,091 days). Infections were identified in 101 (23%) cases. There were 99 cases (22%) of incisional hernia and 32 cases (7%) of small bowel obstruction. Logistic regression revealed SSI to be independently associated with incisional hernia after adjusting for clinical covariates (adjusted odds ratio = 2.23, P =.003; 95% confidence interval, 1.33.8). Patients with incisional hernia were 1.9 times more likely to have had an SSI (36.3% vs 18.8%, P ≤.01). They required a longer operative time (224 minutes vs 198 minutes, P =.03), had an increased body mass index (29.0 vs 26.8, P ≤.01), and had increased estimated blood loss (363 vs 289, mL, P =.03). Small bowel obstruction was significantly associated with operations involving the rectum (11.5% in operations involving the rectum vs 5.9% in nonrectal operations, P =.05), increased estimated blood loss (409 ml vs 297 ml, P =.04), and red blood cell transfusion (15.5% with transfusion vs 5.7% without, P =.01). SSI was not an independent predictor of small bowel obstruction (adjusted odds ratio = 1.05, P =.91; 95% confidence interval,.452.5). Conclusions: Patients with an SSI were 1.9 times more likely to have an incisional hernia than those without an SSI. An SSI after colorectal surgery was a risk factor for the development of incisional hernia but was not a risk factor for small bowel obstruction in our population.

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