TY - JOUR
T1 - Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties
AU - on behalf of the Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Group
AU - Bozzay, Joseph D.
AU - Walker, Patrick F.
AU - Schechtman, David W.
AU - Shaikh, Faraz
AU - Stewart, Laveta
AU - Carson, M. Leigh
AU - Tribble, David R.
AU - Rodriguez, Carlos J.
AU - Bradley, Matthew J.
N1 - Funding Information:
The authors declare no conflicts of interest. Support for this work (IDCRP-024) was provided by the Infectious Disease Clinical Research Program, a Department of Defense program executed through the Uniformed Services University of the Health Sciences, and Department of Preventive Medicine and Biostatistics through a cooperative agreement with The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. This project has been funded by the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under Inter-Agency Agreement Y1-AI-5072, the Defense Health Program, US Department of Defense, under award HU0001190002, and the Department of the Navy under the Wounded, Ill, and Injured Program (HU0001-10-1-0014). The funders had no role in study design, data collection, data analysis, data interpretation, or writing the article. All authors approved the final version of this article. The views expressed are those of the authors and do not reflect the official views of the Uniformed Services University of the Health Sciences, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the National Institute of Health or the Department of Health and Human Services, Brooke Army Medical Center, Walter Reed National Military Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of Defense, the Departments of the Army, Navy or Air Force, or the US Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the US Government.
Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/8
Y1 - 2021/8
N2 - BACKGROUND: Surgical site infections (SSIs) are well-recognized complications after exploratory laparotomy for abdominal trauma; however, little is known about SSI development after exploration for battlefield abdominal trauma. We examined SSI risk factors after exploratory laparotomy among combat casualties. METHODS: Military personnel with combat injuries sustained in Iraq and Afghanistan (June 2009 to May 2014) who underwent laparotomy and were evacuated to participating US military hospitals were included. Log-binominal regression was used to identify SSI risk factors. RESULTS: Of 4,304 combat casualties, 341 patients underwent a total of 1,053 laparotomies. Abdominal SSIs were diagnosed in 49 patients (14.4%): 8% with organ space SSI, 4% with deep incisional SSI, and 4% with superficial SSIs (4 patients had multiple SSIs). Patients with SSIs had more colorectal (p < 0.001), small bowel (p = 0.010), duodenum (p = 0.006), pancreas (p = 0.032), and abdominal vascular injuries (p = 0.040), as well as prolonged open abdomen (p = 0.004) and more infections diagnosed before the SSI (or final exploratory laparotomy) versus non-SSI patients (p < 0.001). Sustaining colorectal injuries (risk ratio [RR], 3.20; 95% confidence interval [CI], 1.58–6.45), duodenum injuries (RR, 6.71; 95% CI, 1.73–25.58), and being diagnosed with prior infections (RR, 10.34; 95% CI, 5.05–21.10) were independently associated with any SSI development. For either organ space or deep incisional SSIs, non–intra-abdominal infections, fecal diversion, and duodenum injuries were independently associated, while being injured via an improvised explosive device was associated with reduced likelihood compared with penetrating nonblast (e.g., gunshot wounds) injuries. Non–intra-abdominal infections and hypotension were independently associated with organ space SSIs development alone, while sustaining blast injuries were associated with reduced likelihood. CONCLUSION: Despite severity of injuries and the battlefield environment, the combat casualty laparotomy SSI rate is relatively low at 14%, with similar risk factors and rates reported following severe civilian trauma.
AB - BACKGROUND: Surgical site infections (SSIs) are well-recognized complications after exploratory laparotomy for abdominal trauma; however, little is known about SSI development after exploration for battlefield abdominal trauma. We examined SSI risk factors after exploratory laparotomy among combat casualties. METHODS: Military personnel with combat injuries sustained in Iraq and Afghanistan (June 2009 to May 2014) who underwent laparotomy and were evacuated to participating US military hospitals were included. Log-binominal regression was used to identify SSI risk factors. RESULTS: Of 4,304 combat casualties, 341 patients underwent a total of 1,053 laparotomies. Abdominal SSIs were diagnosed in 49 patients (14.4%): 8% with organ space SSI, 4% with deep incisional SSI, and 4% with superficial SSIs (4 patients had multiple SSIs). Patients with SSIs had more colorectal (p < 0.001), small bowel (p = 0.010), duodenum (p = 0.006), pancreas (p = 0.032), and abdominal vascular injuries (p = 0.040), as well as prolonged open abdomen (p = 0.004) and more infections diagnosed before the SSI (or final exploratory laparotomy) versus non-SSI patients (p < 0.001). Sustaining colorectal injuries (risk ratio [RR], 3.20; 95% confidence interval [CI], 1.58–6.45), duodenum injuries (RR, 6.71; 95% CI, 1.73–25.58), and being diagnosed with prior infections (RR, 10.34; 95% CI, 5.05–21.10) were independently associated with any SSI development. For either organ space or deep incisional SSIs, non–intra-abdominal infections, fecal diversion, and duodenum injuries were independently associated, while being injured via an improvised explosive device was associated with reduced likelihood compared with penetrating nonblast (e.g., gunshot wounds) injuries. Non–intra-abdominal infections and hypotension were independently associated with organ space SSIs development alone, while sustaining blast injuries were associated with reduced likelihood. CONCLUSION: Despite severity of injuries and the battlefield environment, the combat casualty laparotomy SSI rate is relatively low at 14%, with similar risk factors and rates reported following severe civilian trauma.
KW - Combat-related
KW - abdominal surgical site infection
KW - exploratory laparotomy
KW - trauma-related infection
UR - http://www.scopus.com/inward/record.url?scp=85112863152&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000003109
DO - 10.1097/TA.0000000000003109
M3 - Article
C2 - 33605707
AN - SCOPUS:85112863152
SN - 2163-0755
VL - 91
SP - S247-S255
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 2
ER -