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What are the Risk Factors for Abdominal Surgical Site Infection after Exploratory Laparotomy among Combat Casualties?

Research Paper Title

Risk Factors for Abdominal Surgical Site Infection after Exploratory Laparotomy among Combat Casualties.

Background

Surgical site infections (SSI) are well-recognised complications after exploratory laparotomy for abdominal trauma; however, little is known about SSI development after exploration for battlefield abdominal trauma. The researchers examined SSI risk factors after exploratory laparotomy among combat casualties.

Methods

Military personnel with combat injuries sustained in Iraq and Afghanistan (6/2009-5/2014) 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 (14.4%) patients; 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 ex-lap) versus non-SSI patients (p<0.001). Sustaining colorectal injuries (risk ratio [RR]: 3.20; 95% 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-intraabdominal infections, faecal diversion, and duodenum injuries were independently associated, while being injured via an improvised explosive device (IED) was associated with reduced likelihood compared to penetrating non-blast (e.g., gunshot wounds) injuries. Non-intraabdominal infections and hypotension were independently associated with organ space SSIs development alone, while sustaining blast injuries were associated with reduced likelihood.

Conclusions

Despite severity of injuries and the battlefield environment, the combat casualty laparotomy SSI rate is relatively low at 14% and is comparable to risk factors and rates reported following severe civilian trauma.

Reference

Bozzay, J.D., Walker, P.F., Schechtman, D.W., Shaikh, F., Stewart, L., Carson, M.L., Tribble, D.R., Rodriguez, C.J., Bradley, M.J. & Infectious Disease Clinical Research Programme Trauma Infectious Disease Outcomes Study Group. (2021) Risk Factors for Abdominal Surgical Site Infection after Exploratory Laparotomy among Combat Casualties. The Journal of Trauma and Acute Care Surgery. doi: 10.1097/TA.0000000000003109. Online ahead of print.

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