Increasing Differences in Surgical Site Infections After Emergency and Elective Colorectal Surgery.

Abstract

Introduction: Surgical site infections (SSIs) are a significant source of morbidity and cost following colorectal surgery. We sought to determine trends in SSI incidence following elective and emergency colorectal surgery, hypothesizing stagnant rates in emergency surgeries due to slower adoption of minimally invasive surgery (MIS).

Methods: We retrospectively analyzed 229,167 patients undergoing colectomy from 2011 to 2021 using the National Surgical Quality Improvement Program database. The primary outcome was trends in SSI rates following elective and emergency cases. Joinpoint regression calculated annual percent changes.

Results: We analyzed 203,622 elective and 16,545 emergency colorectal surgeries. While the rate of any SSI following elective colorectal surgery declined significantly, no change was observed in emergency surgery. When comparing types of SSI, superficial SSI decreased at a greater rate in elective surgery compared to emergency surgery. Deep SSI decreased significantly for elective but not emergency surgery. Organ space SSI increased at a greater rate in emergency surgery. Upon subanalysis, the use of MIS increased at a greater rate in emergency surgery. Elective MIS maintained a significant downtrend in any, superficial, and deep SSIs, while emergency MIS did not show any significant trends.

Conclusions: There is an increasing difference in SSI rates between emergency and elective colorectal surgery. Emergency cases show no significant change in any or deep SSI rates, smaller declines in superficial SSIs, and a greater increase in organ space SSIs compared to elective cases. This difference persists despite greater MIS utilization in emergency surgery and between emergency and elective MIS.