title: The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery.
abstract: BACKGROUND
  The purpose of this study was to evaluate the long-term complications of surgical site infection (SSI) in the colorectal population, specifically its association with incisional hernia and small bowel obstruction.
  
  
  METHODS
  Using standardized definitions of SSI, a retrospective review of patients undergoing transabdominal colorectal surgery from January 2002 to December 2005 was performed. Primary outcomes included incisional hernia and small bowel obstruction in patients with SSIs.
  
  
  RESULTS
  A total of 443 patients were analyzed. The median surgical follow-up was 12 months (2-3,091 days). Infections were identified in 101 (23%) cases. There were 99 cases (22%) of incisional hernia and 32 cases (7%) of small bowel obstruction. Logistic regression revealed SSI to be independently associated with incisional hernia after adjusting for clinical covariates (adjusted odds ratio = 2.23, P = .003; 95% confidence interval, 1.3-3.8). Patients with incisional hernia were 1.9 times more likely to have had an SSI (36.3% vs 18.8%, P ≤ .01). They required a longer operative time (224 minutes vs 198 minutes, P = .03), had an increased body mass index (29.0 vs 26.8, P ≤ .01), and had increased estimated blood loss (363 vs 289, mL, P = .03). Small bowel obstruction was significantly associated with operations involving the rectum (11.5% in operations involving the rectum vs 5.9% in nonrectal operations, P = .05), increased estimated blood loss (409 ml vs 297 ml, P = .04), and red blood cell transfusion (15.5% with transfusion vs 5.7% without, P = .01). SSI was not an independent predictor of small bowel obstruction (adjusted odds ratio = 1.05, P = .91; 95% confidence interval, .45-2.5).
  
  
  CONCLUSIONS
  Patients with an SSI were 1.9 times more likely to have an incisional hernia than those without an SSI. An SSI after colorectal surgery was a risk factor for the development of incisional hernia but was not a risk factor for small bowel obstruction in our population.
authors.affiliation: Dallas VA Medical Center, Surgical Services (112), 4500 S Lancaster Road, Dallas, TX 75216, USA. brycew.murray@va.gov
authors.forename: Bryce W
authors.initials: BW
authors.lastname: Murray
authors.forename: Daisha J
authors.initials: DJ
authors.lastname: Cipher
authors.forename: Thai
authors.initials: T
authors.lastname: Pham
authors.forename: Thomas
authors.initials: T
authors.lastname: Anthony
mesh_terms: D016063:Blood Loss, Surgical; D015992:Body Mass Index; D003106:Colon / Q000601:surgery*; D017707:Erythrocyte Transfusion; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000150:complications*; D013997:Time Factors