title: Infectious Complications after Major Abdominal Cancer Surgery: In Search of Improvable Risk Factors.
abstract: BACKGROUND
  Major resections for esophageal, gastric, hepatic, pancreatic, and colorectal cancer continue to be associated with a high peri-operative morbidity of up to 30%-40%. To a large extent, this morbidity is caused by infectious complications that add up to a considerable burden to patients and hospital costs. The objective of this large retrospective cross-sectional study was to determine independent patient and operation-related risk factors for infectious complications after major abdominal cancer operations to elucidate how infection rates can be reduced and improve health-care quality.
  
  
  METHODS
  In 1,389 cancer patients who underwent a major resection procedure between 2009 and 2013, infectious complications and their independent determinants were analyzed by multivariable logistic regression (p < 0.05).
  
  
  RESULTS
  Male gender was a risk factor for infections in general, whereas patients ≥65 y (odds ratio [OR] 1.75; p = 0.008), urinary tract infection (OR 0.51; p = 0.004), American Society of Anesthesiologists score (OR 1.55; p = 0.004), overall (OR 1.70; p = 0.037), vascular (OR 1.59; p = 0.020), and neurologic comorbidity (OR 2.22; p = 0.001) were associated significantly with pneumonia. Intra-abdominal drainage (OR 1.41; p = 0.024) and a duration of surgery of ≥180 min (OR 1.85; p = 0.001) were risk factors for surgical site infections. Total parenteral nutrition was significantly associated with intravascular catheter-induced infections (OR 18.09; p < 0.001) and sepsis (OR 6.69; p < 0.001).
  
  
  CONCLUSIONS
  In this study, several independent risk factors for infectious complications in major abdominal cancer operations were identified, providing opportunities for further reducing peri-operative infections. General awareness and focus on preventing infectious complications may have a significant impact on health-care outcomes and costs.
authors.affiliation: 1 Laboratory of Clinical Microbiology and Infectious Diseases , Isala, Zwolle, The Netherlands .
authors.forename: Linda C
authors.initials: LC
authors.lastname: Smit
authors.affiliation: 1 Laboratory of Clinical Microbiology and Infectious Diseases , Isala, Zwolle, The Netherlands .
authors.forename: Marjan J
authors.initials: MJ
authors.lastname: Bruins
authors.affiliation: 2 Department of Surgery, Isala, Zwolle, The Netherlands .
authors.forename: Gijs A
authors.initials: GA
authors.lastname: Patijn
authors.affiliation: 1 Laboratory of Clinical Microbiology and Infectious Diseases , Isala, Zwolle, The Netherlands .
authors.forename: Gijs J H M
authors.initials: GJ
authors.lastname: Ruijs
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*