Epidural anesthesia not associated with decreased 30-day surgical site infection occurrence after open colorectal surgery.

Abstract

Objective: Surgical site infections (SSI) after colorectal surgery are common. Epidural anesthesia (EA) has demonstrated multiple beneficial effects for patients undergoing open colorectal surgery. However, research regarding the relationship between EA and SSI after open colorectal surgery remains limited.

Methods: This retrospective study analyzed 2022-2023 data from the American College of Surgeons National Surgical Quality Improvement Project registry. Patients were included if they received a colorectal procedure without additional minor or major therapeutic procedures. Generalized additive models evaluated 30-day occurrence of any SSI (primary outcome), as well as incisional SSI and organ-space SSI (secondary outcomes). A sensitivity analysis of the primary outcome incorporated propensity score weighting to account for treatment selection.

Results: Of the 6,343 patients included in the data set, 1,495 (24%) received EA and 3,391 (53%) received colorectal resection. EA was not significantly associated with any SSI (OR 1.11, 95% confidence interval (CI) 0.93-1.33, P = .26), superficial/deep incisional SSI (OR = 1.24, 95% CI 0.96-1.61, P = .11), or organ-space SSI (OR 1.00, 95% CI 0.80-1.25, P = .98). The primary findings were consistent in the sensitivity analysis (OR 0.91, 95% CI 0.77-1.08, P = .27). Patients undergoing enterostomy procedures were more likely to experience all three SSI outcomes relative to those who received colorectal resections without enterostomies.

Conclusion: There was a lack of significant differences in the odds of SSI between patients who did and did not receive EA for elective open colorectal surgery.