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. 2021 Nov 9:11:705335.
doi: 10.3389/fonc.2021.705335. eCollection 2021.

Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

Chen Sun  1 , Hui Gao  1 , Yuelun Zhang  2 , Lijian Pei  1   3 , Yuguang Huang  1
Affiliations

Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

Chen Sun et al. Front Oncol. .

Abstract

Background: Organ/space surgical site infection (organ/space SSI) is a serious postoperative complication, closely related to a poor prognosis. Few studies have attempted to stratify the risk of organ/space SSI for patients with advanced digestive system cancer. This study aimed to identify a simple risk stratification for these patients based on perioperative factors.

Methods: The study was based on two randomized controlled trials (RCT) (NCT02715076, ChiCTR-IPR-17011099), including 839 patients undergoing elective radical resection of advanced digestive system cancer. The primary outcome was organ/space SSI within 30 days after surgery. Multivariable logistic regression model was used to identify risk factors. The risk of organ/space SSI stratified over those risk factors was compared using chi-square tests and the relative risk (RR) was estimated.

Results: Among the 839 patients, 51 developed organ/space SSI (6.1%) within 30 days after surgery. According to the multivariable logistic regression model, 3 procedure types, including gastrectomy (OR=8.22, 95% CI: 2.71-24.87, P<0.001), colorectal resection (OR=8.65, 95% CI: 3.13-23.85, P<0.001) and pancreatoduodenectomy (OR=7.72, 95% CI: 2.95-20.21, P<0.001), as well as anaesthesia time > 4 h (OR=2.38, 95% CI: 1.08-5.27, P=0.032) and prolonged ICU stay (OR=4.10, 95% CI: 1.67-10.10, P=0.002), were risk factors for postoperative organ/space SSI. The number of risk factors was significantly associated with an increased risk of organ/space SSI (P<0.001), which was 2.8% in patients with 0-1 risk factor (RR=0.20, 95% CI: 0.11-0.35), 13.0% in patients with 2 risk factors (RR=3.64, 95% CI: 2.14-6.20) and 35.7% in patients with 3 risk factors (RR=6.41, 95% CI: 3.01-13.65).

Conclusion: This study is a preliminary exploratory and provides a simple risk stratification to identify the risk of postoperative organ/space SSI for patients with advanced digestive system cancer. Further research is needed to validate and generalize the results in a wider population.

Clinical trial registration: ClinicalTrials.gov, identifier NCT02715076; Chinese Clinical Trial Registry [https://www.chictr.org.cn/enindex.aspx], identifier ChiCTR-IPR-17011099.

Keywords: advanced digestive system cancer; organ/space surgical site infection; perioperative management; postoperative complication; risk stratification.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Forest Plot about Risk Factors for Organ/Space Surgical Site Infection (Multivariable Analysis) in Advanced Digestive System Cancer. Odds ratios and 95% CIs are shown, derived from the multivariable logistic regression model (Hosmer-Lemeshow test: P=0.881). CI, confidence interval; PN, parenteral nutrition.
Figure 2
Figure 2
ROC Curve of the Multivariable Analysis of Organ/Space Surgical Site Infection. ROC, receiver operating characteristic; AUC, area under the curve; CI, confidence interval.
See this image and copyright information in PMC

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