Diagnosis of colorectal and emergency surgical site infections in the era of enhanced recovery: an all‐Wales prospective study. (18th February 2021)

• Record Type: Journal Article
• Authors: Reeves, Nicola; Cuff, Simone; Boyce, Kathryn; Harries, Rhiannon; Roberts, Christopher; Harrison, Wendy; Torkington, Jared
• Other Names: Alqallaf Abdullah investigator.; Ben Sassi Abozed investigator.; Ashby Alena investigator.; Tang Alethea investigator.; Deans Andrew investigator.; Maw Andrew investigator.; Joseph Anton investigator.; Bos Anya investigator.; Chalklin Chris investigator.; Houlden Chris investigator.; Joyner Claire investigator.; Davies Dawn investigator.; Harris Dean investigator.; MacGowan Drew investigator.; Williams Gethin investigator.; Perry Helen investigator.; Sagkriotis Ioannis investigator.; Long Jennifer investigator.; Waterman Jenny investigator.; Hilton Joanna investigator.; Da Silva Louise investigator.; Iqbal Maria investigator.; Saunders Matthew investigator.; Shah Parin investigator.; Dhruva‐Rao Pawan investigator.; Delicata Ray J. investigator.; Barnett Rebecca E. investigator.; Wood Simon investigator.; Lewis Sophie investigator.; Cornish Julie investigator.; Horwood James investigator.; Phillips Simon investigator.; Morris Chris investigator.; Davies Leigh investigator.; Davies Michael investigator.; Ansell James investigator.; Hargest Rachel investigator.; Vogel Irene investigator.; Shinkwin Michael investigator.; Parker Jody investigator.; Umughele Otumeluke investigator.; Clarkson Martin investigator.;
• Is Part Of: Colorectal disease. Volume 23:Number 5(2021)
• Page Start: 1239
• Page End: 1247
• Publication Date: 2021-02-18
• Subjects: colorectal surgery -- surgical complications -- surgical site infection -- wound infection; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.15569
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: Surgical site infections (SSIs) are associated with increased morbidity, hospital stay and cost. The literature reports that 25% of patients who undergo colorectal surgical procedures develop a SSI. Due to the enhanced recovery programme, patients are being discharged earlier with some SSIs presenting in primary care, making accurate recording of SSIs difficult. The aim of this study was to accurately record the 30‐day SSI rate after surgery performed by colorectal surgeons nationally within Wales. Method: During March 2019, a national prospective snapshot study of all patients undergoing elective or emergency colorectal and general surgical procedures under the care of a colorectal consultant at 12 Welsh hospitals was completed. There was a multimodal 30‐day follow‐up using electronic records, clinic visits and/or telephone calls. Diagnosis of SSI was based on Centers for Disease Control and Prevention diagnostic criteria. Results: Within Wales, of the 545 patients included, 13% developed a SSI within 30 days, with SSI rates of 14.3% for elective surgery and 11.7% for emergency surgery. Of these SSIs, 49.3% were diagnosed in primary care, with 28.2% of patients being managed exclusively in the community. There were two peaks of diagnosis at days 5–7 and days 22–28. SSI rates between laparoscopic (8.6%) and open (16.2%) surgeries were significantly different ( p = 0.028), and there was also a significantly different rate of SSI between procedure groups ( p = 0.001), with high SSI rates for colon (22%) and rectal (18.9%) surgery compared with general surgical procedures. Conclusion: This first all‐Wales prospective study demonstrated an overall SSI rate of 13%. By incorporating accurate primary care follow‐up it was found that 49.3% of these SSIs were diagnosed in primary care.