Post-discharge surgical site infections after uncomplicated elective colorectal surgery: impact and risk factors. The experience of the VINCat Program

J Hosp Infect. 2014 Feb;86(2):127-32. doi: 10.1016/j.jhin.2013.11.004. Epub 2013 Dec 1.

Abstract

Background: Surgical site infection (SSI) after colorectal procedures represents a measurable quality indicator of a healthcare system. There is an increasing interest in comparing SSI rates between different hospitals and countries: however, the variability of the data regarding the incidence of SSI makes this comparison difficult. For the purposes of evaluation, data collection must be standardized and must include reliable post-discharge surveillance (PDS).

Aim: To determine impact and risk factors for PDS SSI after elective colorectal surgery.

Methods: VINCat is a nosocomial infection surveillance programme in Catalonia, Spain. Between 2007 and 2011, 52 hospitals joined the programme. Hospitals performed active, prospective, standardized surveillance of elective colorectal resection. PDS was implemented by a multimodal approach and was mandatory within the first 30 days after surgery.

Findings: During the study period, 13,661 elective colorectal procedures were included. SSI was diagnosed in 2826 (20.7%) patients, of whom 22.5% during PDS; of these, 52% required readmission. Patients with PDS SSI were younger (odds ratio: 1.57; 95% confidence interval: 1.29-1.91), predominantly female (1.40; 1.16-1.69), had more frequently undergone endoscopic procedures (1.56; 1.30-1.88) and had more incisional SSI (1.88; 1.54-2.28) than patients with in-hospital SSI.

Conclusion: SSI rates in elective colorectal procedures at VINCat hospitals were inside the higher range of those reported by other national programmes. PDS SSI increased the overall rate of SSI, had a significant clinical impact, and accounted for almost a quarter of SSI. Younger age and laparoscopic procedures were the most relevant risk factors. Standardized multimodal PDS should be implemented for hospitals performing surveillance of colorectal surgery.

Keywords: Colon surgery; Post-discharge infections; Risk factors; Surgical site infections; Surveillance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Colorectal Surgery / adverse effects*
  • Elective Surgical Procedures / adverse effects*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Risk Factors
  • Spain / epidemiology
  • Surgical Wound Infection / epidemiology*