Incidence and Risk Factors for Incisional Surgical Site Infection After Crohn’s Disease Undergoing Bowel Resection

Abstract

Background: Patients with Crohn’s disease (CD) are often considered at high risk for incisional surgical site infections (SSI). The objective of this study was to identify the risk factors associated with post-operative incisional SSI in CD patients after bowel resection.

Method: CD patients undergoing bowel resection between 2015 to 2016 were enrolled. Demographic and clinical factors related to post-operative incisional SSI were analyzed using both univariate and multivariate logistic regression analyses.

Results: A total of 59 eligible patients were included in the study, of which 77.4% were male, with a mean age of 33.4 ± 11.8 years at the time of surgery. Among these, 22.0% developed post-operative incisional SSI. Factors significantly associated with a higher risk of post-operative incisional SSI included penetrating disease type (P = 0.018), bowel resection for chronic fistula (P = 0.005), and intra-operative findings of fistula (P = 0.001). Additionally, a greater proportion of patients with post-operative incisional SSI had anemia (P = 0.019), elevated white blood cell (P = 0.027) and neutrophil counts (P = 0.006), as well as a higher percentage of neutrophils (P = 0.005). Multivariate logistic regression analysis revealed that anemia (odds ratio [OR]: 3.31, 95% confidence interval [CI]: 1.05–10.46, P = 0.041), an elevated percentage of neutrophils (OR: 2.85, 95% CI: 1.23–6.59, P = 0.014), and an intra-operative finding of fistula (OR: 3.76, 95% CI: 1.53–9.21, P = 0.004) were significantly associated with the risk for post-operative incisional SSI.

Conclusions: Anemia, an elevated percentage of neutrophils, and an intra-operative finding of fistula are significant predictors of post-operative incisional SSI in CD patients undergoing bowel resection. Maintaining favorable pre-operative nutritional status and reducing inflammatory markers may help decrease the incidence of post-operative incisional SSI.

Key words: Crohn’s disease; incisional surgical site infection; risk factors; bowel resection.