Deep and organ/space infections in patients undergoing elective colorectal surgery: incidence and impact on hospital length of stay and costs

Abstract 

Background

The reported incidence of infection complicating elective colorectal surgery (ECS) is 11% to 26%. We evaluated length of stay (LOS) and expense associated with such infections, which heretofore remain unexplored.

Methods

We reviewed 1127 ECS procedures from October 2005 to may 2007 to identify infected case subjects (n = 46). Data were obtained by way of chart abstraction and administrative database review. A case-control study evaluated LOS and actual accounting costs for case subjects versus uninfected control subjects (n = 46). Logistic regression determined risk factors for infection.

Results

Infection incidence was 4.1%. Mean ± SD LOS and costs were greater for case than control subjects: 21 ± 15 days compared with 6 ± 4 days (P < .001) and $42,516 ± 39,972 compared with $10,999 ± $7,122 (P < .001). Procedure type, infection, chronic obstructive pulmonary disease, increased age, and nonsmoking status predicted greater LOS and costs. Infection risk factors included duration of procedure ≥3 hours, male sex, higher American Society of Anesthesiologists (ASA) score, low baseline hematocrit, and indication for surgery of regional enteritis/ulcerative colitis.

Comments

Infection development after ECS is infrequent in our population, but it results in significantly poorer outcomes. Vigilant adherence to preventive guidelines, including those for antibiotic prophylaxis, is warranted.

Keywords: Elective colorectal surgery, Surgical-site infection, Antibiotic prophylaxis, Health outcomes