title: Surgical site infections in colon surgery: the patient, the procedure, the hospital, and the surgeon.
abstract: OBJECTIVE
  To determine the role of the surgeon in the occurrence of surgical site infection (SSI) following colon surgery, with respect to his or her adherence to guidelines and his or her experience.
  
  
  METHODS
  Prospective cohort study of 2393 patients who underwent colon surgery performed by 31 surgeons in 9 secondary and tertiary care public Swiss hospitals, recruited from a surveillance program for SSI between March 1, 1998, and December 31, 2008, and followed up for 1 month after their operation.
  
  
  METHODS
  Risk factors for SSI were identified in univariate and multivariate analyses that included the patients' and procedures' characteristics, the hospitals, and the surgeons as candidate covariates. Correlations were sought between surgeons' individual adjusted risks, their self-reported adherence to guidelines, and the delay since their board certification.
  
  
  RESULTS
  A total of 428 SSIs (17.9%) were identified, with hospital rates varying from 4.0% to 25.2% and individual surgeon rates varying from 3.7% to 36.1%. Features of the patients and procedures associated with SSI in univariate analyses were male sex, age, American Society of Anesthesiologists score, contamination class, operation duration, and emergency procedure. Correctly timed antibiotic prophylaxis and laparoscopic approach were protective. Multivariate analyses adjusting for these features and for the hospitals found 4 surgeons with higher risk of SSI (odds ratio [OR] = 2.37, 95% confidence interval [CI], 1.51-3.70; OR = 2.19, 95% CI, 1.41-3.39; OR = 2.15, 95% CI, 1.02-4.53; and OR = 1.97, 95% CI, 1.18-3.30) and 2 surgeons with lower risk of SSI (OR = 0.43, 95% CI, 0.19-0.94; and OR = 0.19, 95% CI, 0.04-0.81). No correlation was found between surgeons' individual adjusted risks and their adherence to guidelines or their experience.
  
  
  CONCLUSIONS
  For reasons beyond adherence to guidelines or experience, the surgeon may constitute an independent risk factor for SSI after colon surgery.
authors.affiliation: Department of Visceral Surgery University Hospital, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
authors.forename: Michele
authors.initials: M
authors.lastname: Diana
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zanetti
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Eisenring
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Nicolas
authors.initials: N
authors.lastname: Troillet
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods; D003108:Colonic Diseases / Q000601:surgery*; D003141:Communicable Diseases / Q000150:complications* / Q000453:epidemiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D010349:Patient Compliance; D010819:Physician's Role; D011159:Population Surveillance; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013557:Switzerland / Q000453:epidemiology