title: Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance.
abstract: OBJECTIVE
  The objective of this study was to clarify the incidence and risk factors for developing incisional surgical site infection (SSI) in both elective colon and rectal surgery.
  
  
  BACKGROUND
  SSI is a frequent complication after elective colorectal resection. The National Nosocomial Infection Surveillance system surveys all colorectal surgeries together, without differentiating the type of colorectal surgery performed. However, rectal surgery may have a higher risk for SSI, and identifying risk factors that are more specific to each procedure would be more predictive.
  
  
  METHODS
  We conducted prospective SSI surveillance of all elective colorectal resections performed by a single surgeon in a single institution from November 2000 to July 2004. The data for colon and rectal surgeries were collected separately. The outcome of interest was incisional SSI. Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery.
  
  
  RESULTS
  A total of 556 colorectal resections, consisting of 339 colon and 217 rectal surgeries, were admitted to the program. The incisional SSI rates in colon and rectal surgeries were 9.4% and 18.0%, respectively (P = 0.0033). Risk factors for developing incisional SSI in colon surgery were ostomy closure (OR = 7.3) and lack of oral antibiotics (OR = 3.3), while in rectal surgery, risk factors were preoperative steroids (OR = 3.7), preoperative radiation (OR = 2.8), and ostomy creation (OR = 4.9).
  
  
  CONCLUSIONS
  Colon and rectal surgeries differ with regard to incidence and risk factors for developing incisional SSI. SSI surveillance for such surgeries should be performed separately, as this should lead to more efficient identification of risk factors and a reduction in SSI.
authors.affiliation: Department of Surgical Oncology, University of Tokyo, Tokyo, Japan. KONISHIT-SUR@h.u-tokyo.ac.jp
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Konishi
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
authors.forename: Junji
authors.initials: J
authors.lastname: Kishimoto
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nagawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*