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JAMA Surgery
Article
Data sources: UnpayWall
JAMA Surgery
Article . 2013 . Peer-reviewed
Data sources: Crossref
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Outcomes and Predictors of Incisional Surgical Site Infection in Stoma Reversal

Authors: Mike K, Liang; Linda T, Li; Andres, Avellaneda; Jennifer M, Moffett; Stephanie C, Hicks; Samir S, Awad;

Outcomes and Predictors of Incisional Surgical Site Infection in Stoma Reversal

Abstract

Surgical site infection following stoma reversal (SR) poses a substantial burden to the patient and health care system. Its overall incidence is likely underreported and poorly characterized. Improving our understanding of surgical site infection following stoma reversal may help us identify methods to decrease this complication.To evaluate the incidence of surgical site infection (SSI) and identify predictors of SSI following SR.A review of computerized hospital records on SR performed from January 1, 2005, until February 27, 2011.An integrated medical system at the Michael E. DeBakey Veterans Affairs Medical Center.All adults undergoing SR during the study period.Rates of SSI and characteristics of patients with and without SSI were compared. A logistic regression model was developed to identify predictors of SSI.One hundred twenty-eight patients underwent SR; 46 patients (36.0%) had an SSI. In comparison with no SSI, the infection was associated with seromas (17.4% vs 2.4%, P = .004), fascial dehiscence (15.2% vs 2.4%, P = .01), intensive care unit admission (34.8% vs 17.1%, P = .03), increased hospital length of stay (20 vs 9 days, P = .02), readmission (32.6% vs 13.4%, P = .01), delayed wound healing (91 vs 66 days, P = .02), and reoperation (32.6% vs 13.4%, P = .01). On multivariate analysis, history of fascial dehiscence (odds ratio, 16.9; 95% CI, 1.94-387), colostomy (5.07; 2.12-13.0), thicker subcutaneous fat (2.02; 1.33-3.21), and black race (0.35; 0.13-0.86) were associated with incisional SSI. There was no significant difference in patient satisfaction or functional status in late follow-up (1-73 months).Surgical site infection is common following SR and is associated with significant morbidity. Four factors are strongly associated with increased risk of SSI in SR: history of fascial dehiscence, thicker subcutaneous fat, colostomy, and white race. Patients with none of these risk factors had a 0% SSI risk; patients with all 4 risk factors had a 100% risk of SSI.

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Keywords

Male, Reoperation, Incidence, Antibiotic Prophylaxis, Length of Stay, Middle Aged, Prognosis, Risk Assessment, Texas, Anti-Bacterial Agents, Survival Rate, Risk Factors, Colostomy, Odds Ratio, Humans, Surgical Wound Infection, Female, Follow-Up Studies, Retrospective Studies

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    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 10%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
58
Top 10%
Top 10%
Top 10%
bronze