Abstract
Introduction
Although surgical site infections (SSIs) associated with colectomy are tracked by
the National Healthcare Safety Network/Center for Disease Control, untracked codes,
mainly related to patients undergoing proctectomy, are not. These untracked codes
are performed less often yet they may be at a greater risk of SSI due to their greater
complexity. Determining the impact and predictors of SSI are critical in the development
of quality improvement initiatives.
Methods
Following an institutional review board approval, National Surgery Quality Improvement
Program, institutional National Surgery Quality Improvement Program, and financial
databases were queried for tracked colorectal resections and untracked colorectal
resections (UCR). National data were obtained for January 2019-December 2019, and
local procedures were identified between January 2013 and December 2019. Data were
analyzed for preoperative SSI predictors, operative characteristics, outcomes, and
30-day postdischarge costs (30dPDC).
Results
Nationally, 71,705 colorectal resections were identified, and institutionally, 2233
patients were identified. UCR accounted for 7.9% nationally and 11.8% of all colorectal
resections institutionally. Tracked colorectal resection patients had a higher incidence
of SSI predictors including sepsis, hypoalbuminemia, coagulopathy, hypertension, and
American Society of Anesthesiologists class. UCR patients had a higher rate of SSIs
[12.9% (P < 0.001), 15.2% (P = 0.064)], readmission, and unplanned return to the operating room. Index hospitalization
and 30dPDC were significantly higher in patients experiencing an SSI.
Conclusions
SSI was associated with nearly a two-fold increase in index hospitalization costs
and six-fold in 30dPDC. These data suggest opportunities to improve hospitalization
costs and outcomes for patients undergoing UCR through protocols for SSI reduction
and preventing readmissions.
Keywords
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Article info
Publication history
Published online: November 22, 2022
Accepted:
October 15,
2022
Received in revised form:
August 26,
2022
Received:
April 12,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
