title: Outcomes and predictors of incisional surgical site infection in stoma reversal.
abstract: OBJECTIVE
  Surgical site infection following stoma reversal (SR) poses a substantial burden to the patient and health care system. Its overall incidence is likely underreported and poorly characterized. Improving our understanding of surgical site infection following stoma reversal may help us identify methods to decrease this complication.
  
  
  OBJECTIVE
  To evaluate the incidence of surgical site infection (SSI) and identify predictors of SSI following SR.
  
  
  METHODS
  A review of computerized hospital records on SR performed from January 1, 2005, until February 27, 2011.
  
  
  METHODS
  An integrated medical system at the Michael E. DeBakey Veterans Affairs Medical Center.
  
  
  METHODS
  All adults undergoing SR during the study period.
  
  
  METHODS
  Rates of SSI and characteristics of patients with and without SSI were compared. A logistic regression model was developed to identify predictors of SSI.
  
  
  RESULTS
  One hundred twenty-eight patients underwent SR; 46 patients (36.0%) had an SSI. In comparison with no SSI, the infection was associated with seromas (17.4% vs 2.4%, P = .004), fascial dehiscence (15.2% vs 2.4%, P = .01), intensive care unit admission (34.8% vs 17.1%, P = .03), increased hospital length of stay (20 vs 9 days, P = .02), readmission (32.6% vs 13.4%, P = .01), delayed wound healing (91 vs 66 days, P = .02), and reoperation (32.6% vs 13.4%, P = .01). On multivariate analysis, history of fascial dehiscence (odds ratio, 16.9; 95% CI, 1.94-387), colostomy (5.07; 2.12-13.0), thicker subcutaneous fat (2.02; 1.33-3.21), and black race (0.35; 0.13-0.86) were associated with incisional SSI. There was no significant difference in patient satisfaction or functional status in late follow-up (1-73 months).
  
  
  CONCLUSIONS
  Surgical site infection is common following SR and is associated with significant morbidity. Four factors are strongly associated with increased risk of SSI in SR: history of fascial dehiscence, thicker subcutaneous fat, colostomy, and white race. Patients with none of these risk factors had a 0% SSI risk; patients with all 4 risk factors had a 100% risk of SSI.
authors: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Operative Care Line, Room 112, 2002 Holcombe Blvd, Houston, TX 77030, USA. ml3@bcm.edu
authors: Mike K
authors: MK
authors: Liang
authors: Linda T
authors: LT
authors: Li
authors: Andres
authors: A
authors: Avellaneda
authors: Jennifer M
authors: JM
authors: Moffett
authors: Stephanie C
authors: SC
authors: Hicks
authors: Samir S
authors: SS
authors: Awad
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents