Factors Predicting Surgical Site Infection in Older Adults Undergoing Abdominal Surgery: A Retrospective Cohort Study
DOI:
https://doi.org/10.60099/prijnr.2024.266861Keywords:
Abdominal surgery, Comorbidity, Obesity, Older adults, Surgical site infectionAbstract
Surgical site infection is a significant health problem among nosocomial infections, leading to post-operative mortality in surgical older adults. Identifying risk factors is essential in surgical care quality. This retrospective cohort study, conducted at a university hospital in Bangkok, rigorously examined the surgical site infection rate and its predictive factors in older adults undergoing abdominal surgery. The study employed convenience sampling to recruit 300 older adults who underwent abdominal surgery using the code of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and completion of electronic medical records between January 1 and December 31, 2020. The instruments used included the Demographic Characteristics Form, the Preoperative Clinical Characteristics Form, the Intraoperative Record Form, and the Post-operative Record Form. The data collected were analyzed using descriptive statistics and binary logistic regression analysis, ensuring a comprehensive and robust analysis of the risk factors for surgical site infection in older adults undergoing abdominal surgery.
The results of this study revealed that 63.25% of participants were female, with a mean age of 74.5 years. The surgical site infection rate was 12 per 100 patients, varying across anatomical locations and surgical procedures, ranging from 0.33% to 5.66%, with colon surgery being the most common. The study identified significant risk factors predicting surgical site infection, including comorbidities and obesity class 2, while the American Society of Anesthesiologists Physical Status class 2 and 3 were identified as protective factors. These findings provide a powerful tool to screen patients at risk of surgical site infection in nursing practice, particularly with older adults undergoing colon surgery, and to prevent surgical site infection.
References
Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222(5):930- 47. doi: 10.1016/j.jamcollsurg.2015.12.026. DOI: https://doi.org/10.1016/j.jamcollsurg.2015.12.026
Gillespie BM, Harbeck E, Rattray M, Liang R, Walker R, Latimer S, Thalib L, Andersson AE, Griffin B, Ware R, Chaboyer W. Worldwide incidence of surgical site infections in general surgical patients: a systematic review and meta-analysis of 488,594 patients. Int J Surg. 2021;95:106136. doi: 10.1016/j.ijsu.2021.106136. DOI: https://doi.org/10.1016/j.ijsu.2021.106136
Marzoug OA, Anees A, Malik EM. Assessment of risk factors associated with surgical site infection following abdominal surgery: a systematic review. BMJ Surg Interv Health Technol. 2023;5(1):e000182. doi: 10.1136/ bmjsit-2023-000182. DOI: https://doi.org/10.1136/bmjsit-2023-000182
Ansari S, Hassan M, Barry HD, Bhatti TA, Hussain SZM, Jabeen S, Fareed S. Risk factors associated with surgical site infections: a retrospective report from a developing country. Cureus. 2019;11(6):e4801. doi: 10.7759/cureus.4801. DOI: https://doi.org/10.7759/cureus.4801
Totty JP, Moss JWE, Barker E, Mealing SJ, Posnett JW, Chetter IC, Smith GE. The impact of surgical site infection on hospitalisation, treatment costs, and health-related quality of life after vascular surgery. Int Wound J. 2021;18(3): 261-8. doi: 10.1111/iwj.13526. DOI: https://doi.org/10.1111/iwj.13526
Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN): patient safety component manual [Internet]. 2021 [cited 2023 Dec 1]. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
O’Brien WJ, Gupta K, Itani KMF. Association of post-operative infection with risk of long-term infection and mortality. JAMA Surg. 2020;155(1):61-8. doi: 10.1001/jamasurg.2019.4539. DOI: https://doi.org/10.1001/jamasurg.2019.4539
Centers for Disease Control and Prevention. Understanding the epidemiologic triangle through infectious disease working the epidemiologic triangle. 2018 Aug 28 [cited 2023 Dec 1]. Available from: https://www.cdc.gov/healthyschools/bam/teachers/documents/epi_1_triangle.pdf
Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, et al. Chronic wound repair and healing in older adults: current status and future research. J Am Geriatr Soc. 2015;63(3):427-38. doi: 10.1111/jgs.13332. DOI: https://doi.org/10.1111/jgs.13332
Weyand CM, Goronzy JJ. Aging of the immune system. Mechanisms and therapeutic targets. Ann Am Thorac Soc. 2016;13(Suppl 5):S422-8. doi: 10.1513/Annals ATS.201602-095AW. DOI: https://doi.org/10.1513/AnnalsATS.201602-095AW
Saravanakumar R, Devi BP. Surgical site infection in a tertiary care centre-an overview-a cross sectional study. Int J Surg. 2019;21(1):12-6. DOI: https://doi.org/10.1016/j.ijso.2019.09.008
Yang J, Zhang X, Liang W. A retrospective analysis of factors affecting surgical site infection in orthopaedic patients. J Int Med Res. 2020;48(4):300060520907776. doi: 10.1177/0300060520907776. DOI: https://doi.org/10.1177/0300060520907776
Bischoff P, Kramer TS, Schröder C, Behnke M, Schwab F, Geffers C, Gastmeier P, Aghdassi SJS. Age as a risk factor for surgical site infections: German surveillance data on total hip replacement and total knee replacement procedures 2009 to 2018. Euro Surveill. 2023;28(9): 2200535. doi:10.2807/1560-7917.ES.2023.28.9.2200535. DOI: https://doi.org/10.2807/1560-7917.ES.2023.28.9.2200535
Larbi A, Rymkiewicz P, Vasudev A, Low I, Shadan NB, Mustafah, S, et al. The immune system in the elderly: a fair fight against diseases. Aging Health. 2013;9(1):35- 47. doi: 10.2217/ahe.12.78. DOI: https://doi.org/10.2217/ahe.12.78
El Chakhtoura NG, Bonomo RA, Jump RLP. Influence of aging and environment on presentation of infection in older adults. Infect Dis Clin North Am. 2017;31(4):593-608. doi: 10.1016/j.idc.2017.07.017. DOI: https://doi.org/10.1016/j.idc.2017.07.017
Omeis IA, Dhir M, Sciubba DM, Gottfried ON, McGirt MJ, Attenello FJ, et al. Post-operative surgical site infections in patients undergoing spinal tumor surgery: incidence and risk factors. Spine (Phila Pa 1976). 2011;36(17):1410-9. doi: 10.1097/BRS.0b013e3181f48fa9. DOI: https://doi.org/10.1097/BRS.0b013e3181f48fa9
Wang LM, Chen ZH, Zhang M, Zhao ZP, Huang ZJ, Zhang X, et al. Study of the prevalence and disease burden of chronic disease in the elderly in China. Chinese J Epidemiol. 2019;40(3):277-83. doi: 10.3760/cma.j.issn.0254-6450.2019.03.005 (in Chinese).
Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, et al. Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1):88-99. doi: 10.1017/ice.2015.249. DOI: https://doi.org/10.1017/ice.2015.249
Doyle DJ, Hendrix JM, Garmon EH. American Society of Anesthesiologists Classification. 2023 Aug 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441940
World Health Organization. Protocol for surgical site infection surveillance with a focus on settings with limited resources [Internet]. 2018 Mar 31 [cited 2023 Dec 1]. Available from: https://www.who.int/publications/i/item/protocol-for-surgical-site-infection-surveillance-with-a-focus-on-settings-with-limited-resources
Alonso Suclla-Velásquez J, Smedts C. Obesity: a risk factor for infection after surgery [Internet]. In: Himmerich H, editor. Weight management. IntechOpen; 2020. Available from: http://dx.doi.org/10.5772/intechopen.91216. DOI: https://doi.org/10.5772/intechopen.91216
Thelwall S, Harrington P, Sheridan E, Lamagni T. Impact of obesity on the risk of wound infection following surgery: results from a nationwide prospective multicentre cohort study in England. Clin Microbiol Infect. 2015;21(11): 1008.e1-8. doi: 10.1016/j.cmi.2015.07.003. DOI: https://doi.org/10.1016/j.cmi.2015.07.003
Winfield RD, Reese S, Bochicchio K, Mazuski JE, Bochicchio GV. Obesity and the risk for surgical site infection in abdominal surgery. Am Surg. 2016;82(4): 331-6. PMID: 27097626. DOI: https://doi.org/10.1177/000313481608200418
World Health Organization. Regional Office for the Western Pacific. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia; 2000. Available from: https://iris.who.int/handle/10665/206936
Skeie E, Koch AM, Harthug S, Fosse U, Sygnestveit K, Nilsen RM, et al. A positive association between nutritional risk and the incidence of surgical site infections: a hospital-based register study. PLoS One. 2018;13(5):e0197344. doi: 10.1371/journal.pone.0197344. DOI: https://doi.org/10.1371/journal.pone.0197344
Tsantes AG, Papadopoulos DV, Lytras T, Tsantes AE, Mavrogenis AF, Koulouvaris P, et al. Association of malnutrition with surgical site infection following spinal surgery: systematic review and meta-analysis. J Hosp Infect. 2020;104(1):111-9. doi: 10.1016/j.jhin.2019.09.015. DOI: https://doi.org/10.1016/j.jhin.2019.09.015
Komindrg S, Tangsermwong T, Janepanish P. Simplified malnutrition tool for Thai patients. Asia Pac J Clin Nutr. 2013;22(4):516-21. doi: 10.6133/apjcn.2013.22.4.06.
Wenzel RP. Surgical site infections and the microbiome: an updated perspective. Infect Control Hosp Epidemiol. 2019;40(5):590-6. doi: 10.1017/ice.2018.363. DOI: https://doi.org/10.1017/ice.2018.363
Thursby E, Juge N. Introduction to the human gut microbiota. Biochem J. 2017;474(11):1823-36. doi: 10.1042/BCJ20160510. DOI: https://doi.org/10.1042/BCJ20160510
Guzmán-García C, Flores-Barrientos OI, Juárez-Rojop IE, Robledo-Pascual JC, Baños-González MA, Tovilla-Záratee CA, et al. Abdominal surgical site infection incidence and risk factors in a Mexican population. Adv Skin Wound Care. 2019;32 (6):1-6. doi: 10.1097/01.ASW.0000557833.80431.00. DOI: https://doi.org/10.1097/01.ASW.0000557833.80431.00
Zabaglo M, Sharman T. Post-operative wound infection. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560533
Burmeister E, Aitken LM. Sample size: how many is enough? Aust Crit Care. 2012;25(4):271-4. doi: 10.1016/j.aucc.2012.07.002. DOI: https://doi.org/10.1016/j.aucc.2012.07.002
Chen H, Cohen P, Chen S. How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat-Simul C. 2010;39(4):860-4. doi:10.1080/03610911003650383. DOI: https://doi.org/10.1080/03610911003650383
Isik O, Kaya E, Dundar HZ, Sarkut P. Surgical site infection: re-assessment of the risk factors. Chirurgia (Bucur). 2015;110(5):457-61. PMID: 26531790.
Krieger Y, Walfisch A, Sheiner E. Surgical site infection following cesarean deliveries: trends and risk factors. J Matern Fetal Neonatal Med. 2017;30(1):8-12. doi: 10.3109/14767058.2016.1163540. DOI: https://doi.org/10.3109/14767058.2016.1163540
Gaebel R, Lang C, Vasudevan P, Lührs L, de Carvalho KAT, Abdelwahid E, et al. New approaches in heart research: prevention instead of cardiomyoplasty. Int J Mol Sci. 2023;24(10):9017. doi: 10.3390/ijms24109017. DOI: https://doi.org/10.3390/ijms24109017
Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev. 2020;16(5):442-9. doi: 10.2174/1573399815666191024085838. DOI: https://doi.org/10.2174/1573399815666191024085838
Gurunathan U, Ramsay S, Mitrić G, Way M, Wockner L, Myles P. Association between obesity and wound infection following colorectal surgery: systematic review and meta-analysis. J Gastrointest Surg. 2017;21(10):1700-12. doi: 10.1007/s11605-017-3494-y. DOI: https://doi.org/10.1007/s11605-017-3494-y
Aga E, Keinan-Boker L, Eithan A, Mais T, Rabinovich A, Nassar F. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study. Infect Dis (Lond). 2015;47(11):761-7. doi: 10.3109/23744235.2015.1055587. DOI: https://doi.org/10.3109/23744235.2015.1055587
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