Diagnosis of colorectal and emergency surgical site infections in the era of enhanced recovery: an all‐Wales prospective study

Aim Surgical site infections (SSIs) are associated with increased morbidity, hospital stay and cost. The literature reports that 25% of patients who undergo colorectal surgical procedures develop a SSI. Due to the enhanced recovery programme, patients are being discharged earlier with some SSIs pres...

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Published in:	Colorectal disease Vol. 23; no. 5; pp. 1239 - 1247
Main Authors:	Reeves, Nicola, Cuff, Simone, Boyce, Kathryn, Harries, Rhiannon, Roberts, Christopher, Harrison, Wendy, Torkington, Jared, Alqallaf, Abdullah, Ben Sassi, Abozed, Ashby, Alena, Tang, Alethea, Deans, Andrew, Maw, Andrew, Joseph, Anton, Bos, Anya, Chalklin, Chris, Houlden, Chris, Joyner, Claire, Davies, Dawn, Harris, Dean, MacGowan, Drew, Williams, Gethin, Perry, Helen, Sagkriotis, Ioannis, Long, Jennifer, Waterman, Jenny, Hilton, Joanna, Da Silva, Louise, Iqbal, Maria, Saunders, Matthew, Shah, Parin, Dhruva‐Rao, Pawan, Delicata, Ray J., Barnett, Rebecca E., Wood, Simon, Lewis, Sophie, Cornish, Julie, Horwood, James, Phillips, Simon, Morris, Chris, Davies, Leigh, Davies, Michael, Ansell, James, Hargest, Rachel, Vogel, Irene, Shinkwin, Michael, Parker, Jody, Umughele, Otumeluke, Clarkson, Martin
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-05-2021
Subjects:	Colon colorectal surgery Diagnosis Laparoscopy Morbidity Patients Primary care Rectum Surgery surgical complications surgical site infection Surgical site infections wound infection United Kingdom > UK Wales surgical complications colorectal surgery wound infection surgical site infection
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Summary:	Aim Surgical site infections (SSIs) are associated with increased morbidity, hospital stay and cost. The literature reports that 25% of patients who undergo colorectal surgical procedures develop a SSI. Due to the enhanced recovery programme, patients are being discharged earlier with some SSIs presenting in primary care, making accurate recording of SSIs difficult. The aim of this study was to accurately record the 30‐day SSI rate after surgery performed by colorectal surgeons nationally within Wales. Method During March 2019, a national prospective snapshot study of all patients undergoing elective or emergency colorectal and general surgical procedures under the care of a colorectal consultant at 12 Welsh hospitals was completed. There was a multimodal 30‐day follow‐up using electronic records, clinic visits and/or telephone calls. Diagnosis of SSI was based on Centers for Disease Control and Prevention diagnostic criteria. Results Within Wales, of the 545 patients included, 13% developed a SSI within 30 days, with SSI rates of 14.3% for elective surgery and 11.7% for emergency surgery. Of these SSIs, 49.3% were diagnosed in primary care, with 28.2% of patients being managed exclusively in the community. There were two peaks of diagnosis at days 5–7 and days 22–28. SSI rates between laparoscopic (8.6%) and open (16.2%) surgeries were significantly different (p = 0.028), and there was also a significantly different rate of SSI between procedure groups (p = 0.001), with high SSI rates for colon (22%) and rectal (18.9%) surgery compared with general surgical procedures. Conclusion This first all‐Wales prospective study demonstrated an overall SSI rate of 13%. By incorporating accurate primary care follow‐up it was found that 49.3% of these SSIs were diagnosed in primary care.
Bibliography:	Presented as a poster presentation at the European Society of Coloproctology Meeting, September 2019. Funding information The study was supported by Public Health Wales through existing resources and staff time, as the project was part of their remit on surgical site infections. Welsh Barbers SSI Research Collaborative: Abdullah Alqallaf, Abozed Ben Sassi, Alena Ashby, Alethea Tang, Andrew Deans, Andrew Maw, Anton Joseph, Anya Bos, Chris Chalklin, Chris Houlden, Claire Joyner, Dawn Davies, Dean Harris, Drew MacGowan, Gethin Williams, Helen Perry, Ioannis Sagkriotis, Jennifer Long, Jenny Waterman, Joanna Hilton, Louise Da Silva, Maria Iqbal, Matthew Saunders, Parin Shah, Pawan Dhruva‐Rao, Ray J. Delicata, Rebecca E. Barnett, Simon Wood, Sophie Lewis, Julie Cornish, James Horwood, Simon Phillips, Chris Morris, Leigh Davies, Michael Davies, James Ansell, Rachel Hargest, Irene Vogel, Michael Shinkwin, Jody Parker, Otumeluke Umughele, Martin Clarkson. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1462-8910 1463-1318
DOI:	10.1111/codi.15569