title: Is patient diagnosis a risk factor for organ space infection after colorectal resections?
abstract: BACKGROUND
  Validated risk adjustment programs do not use patient diagnosis as a potential covariate in the evaluation of organ space infections.
  
  
  OBJECTIVE
  We hypothesized that patient diagnosis is an important risk factor for organ space infection after colorectal resections.
  
  
  METHODS
  We conducted a retrospective cohort study abstracting data from the American College of Surgeons National Surgical Quality Improvement Program from January 2005 through December 2009.
  
  
  METHODS
  Patients who underwent 1 of 3 types of colorectal resections (ileocolostomy, partial colectomy, and coloproctostomy) were identified by the use of Current Procedural Terminology codes. We excluded patients with concomitant formation of diverting or end stoma.
  
  
  METHODS
  The primary outcome measured was organ space infection.
  
  
  METHODS
  Validated risk adjustment models were used with the addition of diagnostic codes.
  
  
  RESULTS
  We identified 52,056 patients who underwent a colorectal resection of whom 1774 patients developed an organ space infection (3.4%) and 894 (50.2%) returned to the operating room for further surgery. For ileocolostomy, operations for endometriosis (OR, 7.8; 95% CI, 1.7-36.6) and intra-abdominal fistula surgery (OR, 3.0; 95% CI, 1.5-6.0) were associated with increased risk of organ space infection. For partial colectomy, operations for intra-abdominal fistula surgery (OR, 2.3; 95% CI, 1.2-4.3), IBD (OR, 2.5; 95% CI, 1.6-3.8), and bowel obstruction (OR, 1.8; 95% CI, 1.2-2.6) were associated with an increased risk of organ space infection. For coloproctostomy, operations for malignant neoplasm (OR, 2.2; 95% CI, 1.1-4.3) and diverticular bleeding (OR, 3.1; 95% CI, 1.1-9.0) were associated with an increased risk of organ space infection.
  
  
  CONCLUSIONS
  This study was limited by the retrospective study design.
  
  
  CONCLUSIONS
  After adjustment for National Surgical Quality Improvement Program covariates, intra-abdominal fistula, endometriosis, and diverticular bleeding were the diagnoses associated with the highest risk of organ space infection following colorectal resections.
authors.affiliation: 1Department of Colorectal Surgery, Lahey Clinic, Burlington, Massachusetts 2Tufts University, Boston, Massachusetts.
authors.forename: Cagla
authors.initials: C
authors.lastname: Eskicioglu
authors.forename: Jason
authors.initials: J
authors.lastname: Nelson
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Roberts
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Read
authors.forename: Jason F
authors.initials: JF
authors.lastname: Hall
authors.forename: David J
authors.initials: DJ
authors.lastname: Schoetz
authors.forename: Rocco
authors.initials: R
authors.lastname: Ricciardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D003106:Colon / Q000601:surgery; D003108:Colonic Diseases / Q000175:diagnosis / Q000601:surgery; D003125:Colostomy / Q000009:adverse effects*; D004240:Diverticulum / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D004715:Endometriosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000601:surgery*; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000601:surgery; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000601:surgery; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000601:surgery; D007416:Intestinal Perforation / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology