title: Risk Factors for Abdominal Incision Infection after Colorectal Surgery in a Saudi Arabian Population: The Method of Surveillance Matters.
abstract: BACKGROUND
  Reported surgical site infection rates range from 2.1% to 40% after colorectal surgery and are believed to be underestimated depending on the method of surveillance. The study aims were to identify an accurate incidence and associated risk factors for abdominal incision surgical site infection after elective open colorectal surgery in a Saudi population.
  
  
  METHODS
  This was a prospective observational longitudinal study of 300 consecutive adult patients, recruited upon admission to an 800-bed tertiary referral center. All consenting adults admitted for elective open colorectal surgery were included. Patients were followed for 36 d post-surgery by two certified and experienced wound care experts who diagnosed abdominal incision surgical site infections. The definition provided by the U.S. Centers for Disease Control and Prevention was used. Statistical analysis was performed using both univariate and multivariable logistic regression.
  
  
  RESULTS
  Data were analyzed for 296 patients; the incidence of abdominal surgical site infection was 30%. Factors associated with surgical site infection by univariate analysis were pre-operative pre-albumin (p=0.04, odds ratio [OR] 0.81, 95% confidence interval [CI] 0.66-0.99); operative difficulty because of truncal obesity (p=0.006, OR 2.19, 95% CI 1.25-3.84) and obesity measured by body mass index (p=0.002, OR 4.00, 95% CI 1.95-8.20). Multivariable analysis identified only two significant risk factors: Pre-operative pre-albumin (p=0.02, OR 0.76, 95% CI 0.60-0.96), and obesity measured by body mass index (BMI; p=0.001, OR 4.71, 95% CI 2.20-10.10).
  
  
  CONCLUSIONS
  Obesity and nutritional status correlated with post-operative abdominal surgical site infection. The method of surveillance and length of follow-up impact the rate reported.
authors.forename: Denise
authors.initials: D
authors.lastname: Hibbert
authors.forename: Alaa S
authors.initials: AS
authors.lastname: Abduljabbar
authors.forename: Samar J
authors.initials: SJ
authors.lastname: Alhomoud
authors.forename: Luai H
authors.initials: LH
authors.lastname: Ashari
authors.forename: Nasser
authors.initials: N
authors.lastname: Alsanea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000009:adverse effects*; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult