Risk factors for surgical site infections in rectal cancer patients

Abstract

Introduction. Rectal cancer surgery is associated with high rates of post-operative complications in which the most common are Surgical Site Infections (SSI).

Materials and methods. Factors responsible for SSI incidence were retrospectively analysed in rectal cancer patients who had undergone surgery at a single centre for oncology between July 2012 and July 2016. The study end-point was patients’ contracting SSI. Statistical analyses were performed by the ‘Statistica 12’ package consisting of the Pearson’s Chi-squared test (χ²), the Kruskal-Wallis test and the Mann-Whitney U-test (with continuity correction). Qualitative variables were analysed using log-linear analysis. The likelihoods of SSI incidence were compared by using odds ratios within 95% confidence limits.

Results. Amongst the 187 patient subjects under observation during their 30 day follow-up, 44 (23.5%) suffered from post-operative complications of which SSI were the most common at 27 (14.4%). In those patients with advanced stage IV cancer, SSI occurred 3-fold more compared to patients with lower stage cancers; respectively 27.3% vs 11.7%, p = 0.021. Multivariate analysis demonstrated that the highest SSI risk was in patients having a low-lying tumour (≤ 5 cm from the anal rim; OR 2.31 (95% CI of 1.15 to 4.62), p = 0.019 and those patients who had undergone Hartmann’s procedure; OR 1.85 (95% CI of 1.04 to 3.31), p = 0.038.

Conclusions. Surgical site infections in rectal cancer patients undergoing surgery occur significantly more in those at advanced stage IV rectal cancer where the tumour is low-lying (0–5 cm from the anal rim) and after having undergone the Hartmann’s procedure.