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Superficial Surgical Infections in Operative Abdominal Trauma Patients: A Trauma Quality Improvement Database Analysis. J Surg Res 2019 Nov;243:496-502

Date

08/05/2019

Pubmed ID

31377489

DOI

10.1016/j.jss.2019.06.101

Scopus ID

2-s2.0-85069958269

Abstract

BACKGROUND: Surgical site infections (SSIs) have a substantial impact on economic and health indices for patients and health-care institutions. The aim of this study was to identify risk factors for superficial SSIs (sSSIs) in operative abdominal trauma patients using a national cohort.

METHODS: A retrospective analysis of adult trauma patients treated within the Trauma Quality Improvement Database who underwent an exploratory laparotomy from 2010 to 2015 was performed. Risk factors for infection were evaluated using χ, Wilcoxon rank-sum, and multivariate logistic regression.

RESULTS: In total, 41,034 patients underwent an exploratory laparotomy for trauma. There were 18,538 (45.6%) penetrating injuries. Additionally, 10,938 (26.7%) patients suffered a hollow viscus injury with one (8484; 20.7%), two (2188; 5.3%), or three or more (266; 0.7%) hollow viscus organs injured, respectively. The sSSI rate was 4.3%. On multivariate analysis, colonic injuries conferred the greatest single organ independent risk for sSSIs (odds ratio [OR] 2.88 [2.41-3.44]), followed by duodenal injuries (OR 1.99 [1.24-3.17]), small bowel injuries (OR 1.54 [1.28-1.84]), gastric injuries (OR 1.41 [1.06-1.89]), body mass index >30 (1.32 [1.14-1.54]), severe Injury Severity Score (16-25) (OR 1.43 [1.19-1.74]), profound Injury Severity Score (>25) (OR 1.76 [1.44-2.15]), and increasing number of hollow viscus injuries with one (OR 2.75 [2.33-3.26]), two (OR 3.82 [2.98-4.89]), or three (OR 6.85 [4.20-11.17]) organs injured, respectively.

CONCLUSIONS: The incidence of sSSI in operative abdominal trauma patients increases with increased body mass index, increased age, location of injury, blood transfusion need, and increasing number hollow viscus injuries. Consideration should be given to avoiding primary skin closure in patients with these risk factors as a way to mitigate SSIs in this patient population.

Author List

Durbin S, DeAngelis R, Peschman J, Milia D, Carver T, Dodgion C

Authors

Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin
Christopher M. Dodgion MD Assistant Professor in the Surgery department at Medical College of Wisconsin
David J. Milia MD Associate Professor in the Surgery department at Medical College of Wisconsin




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