Patient-related risk factors for surgical site infection following eight types of gastrointestinal surgery

Objective To identify patient-related risk factors for surgical site infection (SSI) following eight types of gastrointestinal surgery that could be collected as part of infection surveillance efforts. Design Record linkage from existing datasets comprising the Japan Nosocomial Infections Surveillance (JANIS) and Diagnosis Procedure Combination (DPC) programmes. Methods Patient data from 35 hospitals were retrieved using JANIS and DPC from 2007 to 2011. Patient-related factors and the incidence of SSI were recorded and analysed. Risk factors associated with SSI were examined using multi-level mixed-effects logistic regression models. Results In total, 2074 appendectomies; 2084 bile duct, liver or pancreatic procedures; 3460 cholecystectomies; 7273 colonic procedures; 482 oesophageal procedures; 4748 gastric procedures; 2762 rectal procedures and 1202 small bowel procedures were analysed. Using multi-variate analyses, intra-operative blood transfusion was found to be a risk factor for SSI following all types of gastrointestinal surgery, except appendectomy and small bowel surgery. In addition, diabetes was found to be a risk factor for SSI following colon surgery [odds ratio (OR) 1.23, P=0.028] and gastric surgery (OR 1.70, P<0.001). Use of steroids was significantly associated with a higher incidence of SSI following cholecystectomy (OR 2.83, P=0.003) and colon surgery (OR 1.27, P=0.040). Conclusions Intra-operative blood transfusion, diabetes and use of steroids are risk factors for SSI following gastrointestinal surgery, and should be included as part of SSI surveillance for these procedures.