title: Surgical site infection after stoma closure in children: outcomes and predictors.
abstract: Surgical site infection (SSI) is a burdensome complication following intestinal stoma closure, with reported rates ranging from 0% to 40%. We aimed to identify risk factors for SSI in children undergoing stoma closure.
  
  
  
  Using 2012-2014 NSQIP Pediatric data, we identified patients aged 0-18 years undergoing stoma closure. Demographic, clinical, and 30-day outcome characteristics between children with and without SSI were compared. A multivariable logistic model was used to identify predictors of SSI.
  
  
  
  Among 2110 children who underwent stoma closure, 7.6% developed SSI. Patients who developed SSI had significantly longer time in the operating room, longer anesthesia times, longer total operation times, and longer lengths of stay (all P ≤ 0.01). Patients who developed SSI postoperatively had significantly higher rates of postoperative complications, including need for postoperative ventilation, sepsis, need for nutritional support on discharge, unplanned reoperation, unplanned readmission, postoperative lengths of stay >30 days, and transfusion within 72 hours after the start of surgery (all P ≤ 0.018). There was a significant relationship between operation time and SSI probability. Specifically, operation time greater than 105 minutes was associated with a higher SSI risk. On adjusted multivariable analyses, age, cardiac risk factors, Hirschsprung disease, and operation time greater than 105 minutes were independently predictive of SSI.
  
  
  
  Longer operation time, age, Hirschsprung disease, and cardiac risk factors are associated with an increased risk for SSI after stoma closure. Studies of perioperative adjuncts to reduce SSI in high-risk children based on expected procedure length and other preoperative characteristics are warranted.
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Dani O
authors.initials: DO
authors.lastname: Gonzalez
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Erica
authors.initials: E
authors.lastname: Ambeba
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: Benedict.Nwomeh@nationwidechildrens.org.
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D054047:Surgical Stomas; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: NSQIP; Ostomy closure; Pediatric; Stoma closure; Surgical site infection