title: How do we understand the disagreement in the frequency of surgical site infection between the CDC and Clavien-Dindo classifications?
abstract: To clarify the discrepancy in the incidence and severity of surgical site infections (SSI) for radical cystectomy between reports based on the CDC guideline and those using the Clavien-Dindo classification we evaluated 449 consecutive patients who underwent radical cystectomy for bladder cancer between 1990 and 2012. Of the 115 (25.6%) patients with SSI defined by the CDC guideline, 89 could be analyzed. We compared the SSI rates and severity defined by the CDC guideline and Clavien-Dindo classifications. There were 58 patients with superficial SSI, 16 with deep SSI, and 15 with organ/space SSI according to the CDC guideline. All patients with organ/space SSI were judged as "not having SSI" by the Clavien-Dindo classification. They were classified as having "intestinal prolapse", "intestinal fistula", "abdominal abscess" and "pelvic abscess." There was a significant association between the treatment duration and depth of SSI based on the CDC guideline by Spearman's rank-correlation coefficient (p < 0.001, r = 0.614) and with the grade of complications (p < 0.001, r = 0.632) in the Clavien-Dindo classification. Multivariate analysis showed that patients with grade III SSI in the Clavien-Dindo classification needed a significantly longer treatment duration. It is necessary to be aware that a discrepancy can occur automatically due to the different natures of the definitions. Using the CDC guideline, we can effectively estimate the future treatment period when SSI occurs. With the Clavien-Dindo classification, grade III SSI requires a longer treatment duration.
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan. Electronic address: takanobu_in_sapporo@yahoo.co.jp.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan. Electronic address: stakahas@sapmed.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ichihara
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hiyama
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan.
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Uehara
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Hashimoto
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Hirobe
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Masumori
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology*; D001749:Urinary Bladder Neoplasms / Q000601:surgery
keywords: Bladder cancer; CDC guideline; Clavien-Dindo classification; Cystectomy; Surgical site infection