Operation time and body mass index are significant risk factors for surgical site infection in laparoscopic sigmoid resection: a multicenter study

Abstract

Surgical site infection (SSI) in patients who underwent colorectal surgery is a common complication associated with increased morbidity and costs. The aim of this study was to assess risk factors for SSI in laparoscopic sigmoid resection for benign disease. Using a multicenter database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery, we prospectively identified 4,488 patients who underwent laparoscopic colorectal surgery between 1995 and 2008; of these, 2,571 patients who underwent sigmoid resection for benign disease were included. Uni- and multivariate analyses were used to determine risk factors for SSI. The incidence of SSI was 3.5% (90/2,571). Among SSI patients, incisional superficial infections were found in 71%, incisional deep infections in 22%, and organ–space infections in 7%. Patients’ age, underlying disease, and surgeons’ experience had no impact on SSI. Multivariate analyses showed that operation time >240 min (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.0–2.8), BMI ≥ 27 kg/m² (OR 2.3 [1.3–4.5]), organ lesions (OR 7.9 [2.0–31.8]), and male gender (OR 2.3 [1.2–4.5]) were significant risk factors for SSI. Reoperations in the SSI group were significantly more frequent than in the Non-SSI group (30% vs. 3%; p < 0.001). SSI was associated with a significantly longer median hospital stay (15 days, range = 2–69 vs. 8 days, range = 1–69; p < 0.001) and higher mortality rate (2.2% vs. 0.4%; p = 0.019). Significant risk factors for SSI were operation time >240 min, BMI ≥27 kg/m², organ lesions, and male gender. SSI was significantly associated with more reoperations, longer hospital stay, and higher mortality rate.