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The Association of Hypotension and the Development of Surgical Site Infection Following Colon Surgery
June 2008
E47
Results: The analysis resulted in an estimated number of 1.3 million hospitalized SSTIs. Largest segments were hospitalized cellulitis, abscesses, cysts (45.7%), followed by skin infection in diabetic patients (18%), decubitus ulcer infections (14.1%), surgical site infections (12.3%), traumatic wound infections (5.4%) and infections in severe burns (4.5%). Conclusions: These findings highlight the substantial burden of SSTIs in the US, in terms of annual hospitalizations, and the clinical variation of patient segments that comprise SSTI. Publication Number 5-38 New Investigator Award Winner Blue Ribbon Award Winner
The Association of Hypotension and the Development of Surgical Site Infection Following Colon Surgery Ruth Terbush-Nelle, RN, BSN, Infection Control Practitioner; Sarah A. Jadin, MPH, Clinical Epidemiologist; H. Gunner Deery, II, MD, Hospital Epidemiologist; Northern Michigan Regional Hospital, Petoskey, MI. Background/Objectives: Surgical site infection (SSI) following colon surgery can be a major complication resulting in significant morbidity and mortality. Tissue perfusion is an important component in wound healing and prevention of infection because it ensures the delivery of oxygen, nutrients, neutrophils and administered antibiotics to the site. Arterial blood pressure is one of several factors that determine the rate of blood flow which directly influences tissue perfusion. In a 243 bed, non-teaching hospital, approximately 160 colon procedures are performed yearly. During the first three quarters of 2007, there appeared to be a marked increase in the number of SSIs. A preliminary chart review of all infections was performed with the only evident risk factor being hypotension. To investigate the significance of hypotension, a case control study was undertaken. Methods: An unmatched case control study was performed. Cases were defined as patients who had a diagnosis of SSI using the standardized definitions from National Health Surveillance Network (NHSN) after undergoing an operative procedure in the colon category of NHSN between January and September 2007. Three non-infected controls for each case were randomly selected from the same population. Age, gender, ASA score, wound class, NHSN risk category and hypotension in the intraoperative, one hour post-procedure (recovery) period and hours 212 post-procedure (post-recovery) period were assessed. A patient was classified as hypotensive if he/she had a systolic blood pressure (SBP) of 90 or less in two or more consecutive readings. The Student’s t test, chi-square analysis, Fisher’s exact test and odds ratio calculations were performed as appropriate using SPSS, version 15.0. Results: Fifteen case patients with SSI after colon surgery and 45 control patients were analyzed. Partial charts were unavailable for two of the cases. Age, gender, ASA score, wound class and NHSN risk category did not significantly differ between the cases and controls. There was a significant association between SSI after colon surgery and hypotension in the post-recovery period (odds ratio [OR], 7.8; confidence interval [CI], 1.6-38.6). Though not significant, there was a positive association between SSI and intraoperative hypotension (OR, 1.5; CI, 0.4-5.5) and recovery period hypotension (OR, 1.8; CI, 0.1-21.5). Conclusions: SSI is a frequent complication of colon surgery. During a nine month period, there was an increase in SSIs with hypotension being frequent among the cases. The case control study performed showed that SSI was highly correlated with hypotension in the post-recovery period. Wound healing begins immediately after surgery necessitating sufficient tissue perfusion and oxygen tension. Our findings suggest that maintenance of adequate arterial pressure during the period after recovery was the most important time in which to ward off infection and promote wound healing. It is during this time that bacteria from contamination during the surgical procedure are becoming established if there are insufficient host defenses. Other studies have investigated the effects of tissue perfusion with interventions such as increased fluid and supplemental oxygen administration. These studies emphasized the importance of tissue perfusion in the intraoperative and initial postoperative periods. In our study, SBP was used as a proxy for tissue perfusion due to the readiness of the data and ease of use. However, further studies are needed which utilize more precise measurements such as devices that measure subcutaneous oxygen tension.
E47
Results: The analysis resulted in an estimated number of 1.3 million hospitalized SSTIs. Largest segments were hospitalized cellulitis, abscesses, cysts (45.7%), followed by skin infection in diabetic patients (18%), decubitus ulcer infections (14.1%), surgical site infections (12.3%), traumatic wound infections (5.4%) and infections in severe burns (4.5%). Conclusions: These findings highlight the substantial burden of SSTIs in the US, in terms of annual hospitalizations, and the clinical variation of patient segments that comprise SSTI. Publication Number 5-38 New Investigator Award Winner Blue Ribbon Award Winner
The Association of Hypotension and the Development of Surgical Site Infection Following Colon Surgery Ruth Terbush-Nelle, RN, BSN, Infection Control Practitioner; Sarah A. Jadin, MPH, Clinical Epidemiologist; H. Gunner Deery, II, MD, Hospital Epidemiologist; Northern Michigan Regional Hospital, Petoskey, MI. Background/Objectives: Surgical site infection (SSI) following colon surgery can be a major complication resulting in significant morbidity and mortality. Tissue perfusion is an important component in wound healing and prevention of infection because it ensures the delivery of oxygen, nutrients, neutrophils and administered antibiotics to the site. Arterial blood pressure is one of several factors that determine the rate of blood flow which directly influences tissue perfusion. In a 243 bed, non-teaching hospital, approximately 160 colon procedures are performed yearly. During the first three quarters of 2007, there appeared to be a marked increase in the number of SSIs. A preliminary chart review of all infections was performed with the only evident risk factor being hypotension. To investigate the significance of hypotension, a case control study was undertaken. Methods: An unmatched case control study was performed. Cases were defined as patients who had a diagnosis of SSI using the standardized definitions from National Health Surveillance Network (NHSN) after undergoing an operative procedure in the colon category of NHSN between January and September 2007. Three non-infected controls for each case were randomly selected from the same population. Age, gender, ASA score, wound class, NHSN risk category and hypotension in the intraoperative, one hour post-procedure (recovery) period and hours 212 post-procedure (post-recovery) period were assessed. A patient was classified as hypotensive if he/she had a systolic blood pressure (SBP) of 90 or less in two or more consecutive readings. The Student’s t test, chi-square analysis, Fisher’s exact test and odds ratio calculations were performed as appropriate using SPSS, version 15.0. Results: Fifteen case patients with SSI after colon surgery and 45 control patients were analyzed. Partial charts were unavailable for two of the cases. Age, gender, ASA score, wound class and NHSN risk category did not significantly differ between the cases and controls. There was a significant association between SSI after colon surgery and hypotension in the post-recovery period (odds ratio [OR], 7.8; confidence interval [CI], 1.6-38.6). Though not significant, there was a positive association between SSI and intraoperative hypotension (OR, 1.5; CI, 0.4-5.5) and recovery period hypotension (OR, 1.8; CI, 0.1-21.5). Conclusions: SSI is a frequent complication of colon surgery. During a nine month period, there was an increase in SSIs with hypotension being frequent among the cases. The case control study performed showed that SSI was highly correlated with hypotension in the post-recovery period. Wound healing begins immediately after surgery necessitating sufficient tissue perfusion and oxygen tension. Our findings suggest that maintenance of adequate arterial pressure during the period after recovery was the most important time in which to ward off infection and promote wound healing. It is during this time that bacteria from contamination during the surgical procedure are becoming established if there are insufficient host defenses. Other studies have investigated the effects of tissue perfusion with interventions such as increased fluid and supplemental oxygen administration. These studies emphasized the importance of tissue perfusion in the intraoperative and initial postoperative periods. In our study, SBP was used as a proxy for tissue perfusion due to the readiness of the data and ease of use. However, further studies are needed which utilize more precise measurements such as devices that measure subcutaneous oxygen tension.