Severity of early diagnosed organ/space surgical site infection in elective gastrointestinal and hepatopancreatobiliary surgery

• Published in: Annals of gastroenterological surgery Vol. 6; no. 3; pp. 445 - 453
• Main Authors: Okui, Jun, Obara, Hideaki, Shimane, Gaku, Sato, Yasunori, Kawakubo, Hirofumi, Kitago, Minoru, Okabayashi, Koji, Kitagawa, Yuko
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.05.2022; John Wiley and Sons Inc; Wiley
• Subjects: abdominal abscess; Abscesses; anastomotic leak; C-reactive protein; digestive system surgical procedures; Fistula; General anesthesia; Hospitalization; Hospitals; Liver transplants; Medical laboratories; Nosocomial infections; Original; Ostomy; pancreatic fistula; Patients; Surgery; Surgical anastomosis; Surgical outcomes; Surgical site infections; surgical wound infection; Surveillance; pancreatic fistula; anastomotic leak; surgical wound infection; abdominal abscess; digestive system surgical procedures
• ISSN: 2475-0328; 2475-0328
• DOI: 10.1002/ags3.12539

Background Organ/space surgical site infection (SSI) is a significant clinical problem. The postdiagnosis course of organ/space SSIs and the impact of its early diagnosis on clinical outcomes are yet to be clarified. Thus, we aimed to investigate the association between the timing of diagnosis and the clinical outcome of organ/space SSI. Methods This retrospective, single‐center cohort study evaluated patients who underwent elective gastrointestinal or hepatopancreatobiliary surgery between 2016 and 2020. Clinical outcomes were compared between the early group (ie, SSI diagnosed until postoperative day [POD] 4) and normal‐late group (ie, SSI diagnosed after POD 5). The primary outcome was the final C‐reactive protein (CRP) level within 14 d after organ/space SSI diagnosis. Results In total, 110 patients were evaluated. The median time of diagnosis was 7 d postoperatively (interquartile range, 5–9 d postoperatively). Compared with the normal‐late group, the early group included a higher proportion of patients with Clavien–Dindo grade ≥IIIb (8/21 vs 11/89, P = .01), higher final CRP value within 14 d after SSI diagnosis (mean, 4.49 mg/dL vs 2.27 mg/dL, P = .01), longer postoperative length of hospitalization (median, 45.0 d vs 33.0 d; P = .028), and worse 1‐y overall survival rate (74.8% vs 89.3%, P = .08). Conclusion Early diagnosed organ/space SSI are originally severe and may therefore be detected earlier. Importantly, early diagnosed organ/space SSI is likely to be severe and refractory. The postdiagnosis course of organ/space SSIs and the impact of its early diagnosis on clinical outcomes are yet to be clarified. In this study the early diagnosed group had a higher final C‐reactive protein level within 14 d after diagnosis. Physicians should be aware that early diagnosed SSI cases are likely to be severe and refractory.