Surgical site infection after colorectal cancer surgery in Maiduguri, north-eastern Nigeria

Abstract

INTRODUCTION Surgical site infection (SSI) is the most frequent nosocomial infection among surgical patients, accounting for 38% of all such infections. 1,2 It increases length of hospital stay, mortality and the cost of care. SSIs cause a substantial burden to the patient, the hospital and third-party payers, and are thus a clinical outcome indicator of fundamental importance. In colorectal surgery, SSI is a frequent cause of morbidity, with a wide range of incidence from 3% to 30%. 3-6 This wide variation in reported rates globally is largely a function of the varying definitions that have been applied to define SSI. In addition, there has been no clear consensus on the risk factors contributing to SSI following colorectal surgery, which has hindered the progress in developing accurate and efficient systems to better measure outcomes. The most widely-used definition for SSIs was provided by the centre for disease control (CDC) in 1992 and updated in 2003. It broadly classified SSIs into incisional SSIs and organ/space SSI. 7 Incisional SSIs were subdivided into superficial (involving skin and subcutaneous tissue), and deep (fascia and muscle ABSTRACT Background: Colorectal surgery is associated with high rates of surgical site infection (SSI). Determining risk factors for SSI may provide information on reducing complications and improving outcome. The aim of this study was to determine the incidence of SSIs in colorectal cancer patients who had colorectal surgery in our centre, and to identify the risk factors for developing SSIs in these patients. Methods: This was a retrospective study of patients who had open colorectal surgery for colorectal cancer over a twelve-year period (2000 to 2012) at the University of Maiduguri Teaching Hospital, Nigeria. SSI included incisional SSI and organ/space SSI within thirty days of the surgery. Results: A total of 56 patient records were analyzed. An infection rate of 33.9% was documented; all 19 infections were incisional SSIs, occurring after surgery involving the rectum and anus. The perineal incision site was involved in 63.2%, of which 75% were superficial. Wound dehiscence occurred in 26.3%. Risk factors identified to be associated with SSIs include pre-operative bowel preparation, peri-operative blood transfusion, stoma creation, tumour location and the type of operation. Conclusions: The rate of SSIs following oncologic colorectal surgery in our centre is high at 33.9%. All the SSIs were incisional, involving surgery of the rectum and anus. The tumour site, type of operation, stoma creation, mechanical bowel preparation and blood transfusion were identified to be associated with SSIs.