The community burden of surgical site infection following elective colorectal resection

Lydia Newton*, Ffion Dewi, Angus McNair, Dawn Gane, Jodie Rogers, Harry Dean, Anne Pullyblank

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

AIM: Surgical site infection (SSI) is common after colorectal surgery. Recent attempts to measure SSI have focused on inpatient SSI and readmissions. This study examined patient-reported SSI at 30 days over 8 years.

METHODS: The Health Protection Agency questionnaire was used to prospectively measure 30-day patient-reported SSI in patients undergoing elective colorectal operations between February 2011 and April 2019. Questionnaires were sent by post and followed up with a phone call. Data relating to hospital stay were prospectively recorded on an enhanced recovery database.

RESULTS: In all, 80.7% (1268) of 1559 patients responded to the questionnaire with an overall SSI rate of 15.9% (201/1268). The majority of patients who reported SSI presented in the community (66.7%) of whom 65% consulted their general practitioner and 35% saw a community nurse. Patient-reported SSI was validated by a health professional in over 90% of cases. Overall, only 1.5% of readmissions and 2% of ward attendances were due to an isolated wound problem. Patients who developed SSI during their index admission had a longer length of stay (11 days vs. 4 days) but there was no difference in delayed discharge or complications between patients with and without SSI, suggesting that a previously described association between SSI and increased length of stay may be due to observational bias.

CONCLUSION: Existing surveillance audits are suboptimal for monitoring SSIs following colorectal surgery as most SSIs present after discharge. There is a need for robust 30-day surveillance with a standardized methodology if comparisons are to be made between units.

Original languageEnglish
Pages (from-to)724-731
Number of pages8
JournalColorectal Disease
Volume23
Issue number3
Early online date21 Nov 2020
DOIs
Publication statusPublished - 24 Mar 2021

Bibliographical note

Funding Information:
A McNair is supported by an NIHR Clinician Scientist (NIHR‐CS‐2017‐17‐010). Further support is provided by the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views and opinions expressed herein are those of the authors and not necessarily those of the UK National Health Service or the National Institute for Health Research.

Publisher Copyright:
© 2020 The Association of Coloproctology of Great Britain and Ireland

Keywords

  • colorectal cancer
  • surgical site infection
  • elective colorectal resection

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