Intra-abdominal infection in patients with abdominal trauma.
OBJECTIVE
Identifying patients with risk factors associated with the development of intra-abdominal infections makes possible early interventions to minimize morbidity and mortality. We sought to determine the incidence of intra-abdominal infection (organ/space surgical site infection) in patients undergoing operation because of abdominal trauma, to identify the risk factors associated with the development of this complication, and to estimate the respective magnitudes of the risk factors.


METHODS
We performed a prospective cohort study in patients older than 12 years who were treated surgically for penetrating or blunt abdominal trauma, with or without other associated lesions.


METHODS
Hospital Universitario San Vicente de Paul in Medellin, Colombia (HUSVP), a level I trauma center for referral and the general community.


METHODS
From November 1, 2000, through August 31, 2002, 916 patients with abdominal trauma were admitted to the HUSVP trauma unit. Of these, we excluded 2 who underwent operation at different institutions; 97 (10.6%) who died within 48 hours after admission; and 55 (6.0%) in whom complete follow-up (until the 30th postoperative day) was not feasible. The final study sample consisted of 762 patients.


METHODS
We performed univariate analysis to explore in an isolated way the behavior of the dependent and independent variables. Bivariate analysis was carried out with each of the independent variables and the main outcome to establish the association between individual risk factors and intra-abdominal infection. Finally, a logistic regression model was developed using the SPSS 10.0 program and the forward method.


RESULTS
Intra-abdominal infection developed in 81 patients (10.6%). Variables independently associated with this complication were an Abdominal Trauma Index greater than 24, abdominal contamination, and admission to the intensive care unit.


CONCLUSIONS
The development of intra-abdominal infection in patients undergoing operation because of abdominal trauma is a complex phenomenon resulting from the multiple risk factors during the preoperative, intraoperative, and postoperative periods. Multivariate logistic regression analysis allowed us to identify an Abdominal Trauma Index greater than 24, contamination of the abdominal cavity, and admission to the intensive care unit as independent risk factors for the development of organ/space surgical site infection.
Morales
Carlos H
CH
Department of Surgery, Hospital San Vicente de Paul, and National School of Public Health, Universidad de Antioquia, Medellín, Colombia.
Villegas
Maria I
MI
Villavicencio
Rafael
R
González
Germán
G
Pérez
Luis F
LF
Peña
Aisar M
AM
Vanegas
Luis E
LE
D018784:Abdominal Abscess / Q000209:etiology* / Q000382:microbiology; D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D002648:Child; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000209:etiology* / Q000382:microbiology; D011183:Postoperative Complications; D012307:Risk Factors; D013530:Surgical Wound Infection