title: Obstructive Sleep Apnea: A Risk Factor for Surgical Site Infection following Colectomy.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is associated with increased systemic oxidative stress, endothelial dysfunction, and activation of pro-inflammatory cascades, which increase host susceptibility to infection. OSA has not been evaluated as a risk factor for surgical site infection (SSI) following colectomy. We hypothesized that OSA increases the risk for SSI after colectomy.
  
  
  METHODS
  We performed a retrospective review of 507 colectomies that took place between August 2011 and September 2013. Forty-two patients carried the diagnosis of OSA prior to surgery. These 42 patients were matched to 68 patients with no OSA for age, body mass index (BMI), diabetes mellitus (DM), reason for surgery and surgical approach.
  
  
  RESULTS
  The rate of SSI was 28.6% (12 of 42) in the patients with and 10.3% (7 of 68) in the patients without OSA (p=0.03). Using logistic regression, the predictors of SSI following colectomy were found to be OSA (odds ratio [OR] of 3.98, 95% confidence interval [CI]=1.29-12.27), and DM (OR of 7.16, 95% CI=2.36-21.96). The average hospital stay after colectomy for patients with OSA complicated with SSI was 16.7 d whereas patients with OSA without SSI stayed 7.4 d (p<0.001). The rate of organ space infections was 9.5% (4 of 42) in the patients with OSA compared with 0 (p=0.02) in patients without OSA.
  
  
  CONCLUSIONS
  OSA is an independent risk factor for SSI following colectomy. Patients with OSA have substantially greater rates of organ space SSI and longer hospital stay.
authors.affiliation: 1 Department of Surgery, University of Minnesota , Minneapolis, Minnesota.|2 Department of Pulmonary and Critical Care, University of Minnesota , Minneapolis, Minnesota.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Fortis
authors.affiliation: 1 Department of Surgery, University of Minnesota , Minneapolis, Minnesota.
authors.forename: Kristin Pokorney
authors.initials: KP
authors.lastname: Colling
authors.affiliation: 1 Department of Surgery, University of Minnesota , Minneapolis, Minnesota.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Statz
authors.affiliation: 1 Department of Surgery, University of Minnesota , Minneapolis, Minnesota.
authors.forename: James J
authors.initials: JJ
authors.lastname: Glover
authors.affiliation: 1 Department of Surgery, University of Minnesota , Minneapolis, Minnesota.
authors.forename: David M
authors.initials: DM
authors.lastname: Radosevich
authors.affiliation: 1 Department of Surgery, University of Minnesota , Minneapolis, Minnesota.
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Beilman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D013530:Surgical Wound Infection / Q000453:epidemiology*