title: What is the effect of stoma construction on surgical site infection after colorectal surgery?
abstract: BACKGROUND
  The aim of our study was to evaluate the effect of stoma creation on deep and superficial surgical site infections after an index colorectal surgical procedure.
  
  
  METHODS
  We designed a retrospective cohort study from the National Surgical Quality Improvement Program. We evaluated all patients who underwent colorectal surgery procedures from January 2005 to December 2009 with or without creation of a stoma and sought to identify the effect of stoma creation on deep and superficial surgical site infections.
  
  
  RESULTS
  A total of 79,775 patients underwent colorectal procedures (laparoscopic 30.7%, open 69.3%), while 8,113 patients developed a surgical site infection (10.2%). The univariate analysis revealed that surgical site infections were much more common in patients with a stoma compared to those with no stoma (11.8% vs. 9.5%, p < 0.0001). On multivariate analysis, stoma construction during the index colorectal procedure (OR 1.3, CI 1.2 to 1.4), ASA class ≥2, smoking, and abnormal body mass index were associated with surgical site infection.
  
  
  CONCLUSIONS
  The construction of a stoma with colorectal procedures is associated with a higher risk of surgical site infection. Although the stoma effect on surgical site infection is attenuated with laparoscopic techniques, the association remained statistically significant.
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Clinic, 41 Mall Road, Burlington, MA, 01805, USA, Rocco.Ricciardi@Lahey.org.
authors.forename: Rocco
authors.initials: R
authors.lastname: Ricciardi
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Roberts
authors.forename: Jason F
authors.initials: JF
authors.lastname: Hall
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Read
authors.forename: Todd D
authors.initials: TD
authors.lastname: Francone
authors.forename: Scott N
authors.initials: SN
authors.lastname: Pinchot
authors.forename: David J
authors.initials: DJ
authors.lastname: Schoetz
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003082:Colectomy / Q000009:adverse effects*; D003125:Colostomy; D005260:Female; D006801:Humans; D007081:Ileostomy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology