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Quality Improvement/Clinical Outcomes

E380: Organ Space Surgical Site Infections in Combined Liver and Colorectal Procedures: Laying the Foundation for Quality Improvement

Introduction: Combined colorectal and liver resection has been associated with high risk of postoperative deep organ space surgical site infections (SSI). This study investigates trends and factors associated with postoperative SSI after combined colorectal and liver resection for metastatic colorectal cancer.

Methods: Consecutive patients undergoing combined liver resection and colorectal procedure (primary tumor resection or ostomy reversal) for colorectal cancer at a high-volume cancer center from November 2013-September 2022 were reviewed for 30-day SSI. Two national standards were used: National Surgical Quality Improvement Program (NSQIP) and National Health Safety Network (NHSN). NSQIP 30-day organ space SSI was selected as primary outcome for multivariable analysis. Antibiotic prophylaxis was categorized as optimal or suboptimal based on agent, timing of administration and intraoperative redosing in accordance with guidelines. Associations were evaluated using logistic regression; variables were selected for the multivariable model using backwards selection with p</span>≤0.10 on univariable analysis.

Results: In 580 combined procedures, the rate of organ space SSI was 16% (n=94) using NSQIP criteria and 11% (n=64) using NHSN criteria. Most (n=70, 74%) were peri-hepatic collections and a minority were associated with bile leak (n=24, 26%) or anastomotic leak (n=14,16%). There was an increase in organ space SSI over time, from 7% in 2014 to 22% in 2021. On multivariable analysis, increased risk of organ space SSI was associated with major liver resection (OR 2.01, 95% CI 1.05, 3.87), ostomy reversal (OR 2.61, 95% CI 1.51, 4.52), transfusion (OR 1.78, 95%CI 0.99, 3.19), and lack of intra-operative drainage (OR 2.07, 95% CI 1.21, 3.53); the increase in organ space SSI in more recent years remained significant after adjusting for these factors (OR 1.14, 95% CI 1.04, 1.26)(Table). Suboptimal antibiotic prophylaxis occurred in 5%, primarily due to inadequate redosing; however, this was not associated with SSI (p=0.9). On sub-analysis of patients undergoing resection of primary tumor, organ space SSI were less common in rectal versus colon resections (10.4% vs 16.7%, p=0.04).

Conclusions: Organ space SSI are common after combined colorectal and liver resection. A novel intervention is needed targeting high-risk procedures, including ostomy reversal and major liver resection.

Learning Objectives:

  • describe the prevalence of organ space surgical site infection (SSI) in combined liver and colorectal procedures
  • describe the most common location of organ space SSI in combined liver and colorectal procedures
  • describe risk factors for organ space SSI in combined liver and colorectal resection