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Preoperative Predictors of Postoperative Surgical Site Infections in Crohn's Disease Patients Undergoing Major Abdominal Operations
Amy L. Lightner*1, Kevin P. Quinn2, Heidi Chua1, Fateh Bazerbachi2, Sunanda V. Kane2
1Colon and Rectal Surgery, Mayo Clinic, Rochester, MN; 2Gastroenterology, Mayo Clinic, Rochester, MN
Background: Approximately two-thirds of patients with Crohn's Disease (CD) will undergo an abdominal or pelvic operation during their disease course. Up to one-fourth of these patients will develop a surgical site infection (SSI) within 30 days following surgery. Not only are SSIs used as a quality metric, but they are a significant source of morbidity, prolonged hospital stays, cause for readmission, and need for further intervention, including antibiotics and additional procedures. We aimed to identify potential modifiable preoperative risk factors associated with the development of postoperative SSI.
Methods: Following IRB approval, billing data was used to generate a list of patients with CD who underwent abdominal and pelvic operations at a tertiary inflammatory bowel disease center between 2014 and 2015. Patient charts were reviewed and pertinent clinical data was abstracted, which included hemoglobin within 72 hours of operation, albumin within 2 months of operation, preoperative immunosuppressive regimens, operation performed, and 30 day postoperative morbidity. Univariate analysis was performed to determine preoperative predictors of postoperative SSIs.
Results: A total of 62 CD patients met inclusion criteria. The average age was 37 years, and 40% were male. The average hemoglobin within 72 hours prior to operation was 11.72 g/dl, and average albumin within 2 months of surgery was 3.64 g/dl. The total incidence of SSI was 22.58% (n=14), of which over half were deep space infection (64.29%; n=9). On univariate analysis, anemia (hemoglobin <10 g/dl) within 72 hours of surgery (OR=0.38[95% CI:0.04-3.2]; p=0.3), steroid use prior to surgery (OR=2.2[95% CI:0.69-7.2]; p=0.17), and anti-TNF use (OR0.9[95% CI: 0.29-3.1]; p=0.9) were not found to be significant predictors of SSI whereas an albumin less than 3.4 g/dl within two months of surgery was significantly associated with SSI (OR 12[CI: 3.3-4.2]; p=<.001).
Conclusions: In patients with CD undergoing major abdominal or pelvic operations, the preoperative nutritional status is important to optimize in order to prevent postoperativeSSIs.
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