A study of relationship between SSI and the positioning of the created stoma by Coloproctectomy and the surgical wound

Background: Surgical Site Infection (SSI) is a type of healthcare-associated infection, and it causes several problems such as increasing the cost of care.  Therefore, it is important to consider the issue of infection control as a quality of health care indicator.

Objective: Researchers believe that one of the risk factors of SSI comes from creating a stoma by Coloproctectomy.  This study would investigate the relationship between the distance measured from the stoma sight to the surgical wound and SSI.

Methods: Prospective cohort study.

Data collection was conducted at 6 different healthcare facilities. Each of them had a special outpatient clinic operated by a Certified Wound Ostomy and Continence nurse.  Candidates were colon cancer patients who had scheduled for elective colorectal surgery to create a stoma.  This study excluded all emergent and reconstructive stoma surgery.  Before starting we obtained approval from the ethical committee of our graduate school and data collection facilities.  Both stoma size and the distance between the stoma and surgical wound on the 1^st, 3^rd, 7^th, 14^th, 21^st, and 30^th post-operation days were measured. Analysis was completed applying descriptive and inferential statistics.  

Results: The subject of this study comprised 25 cases of which 15 were male and 10 were female .  The average age at surgery was 70.2 ± 9.3 years old.  SSIs were found in Nine cases of 25, and the infection rate was 36%.  SSIs occurred in 2 cases of 9 for those who had colon surgery and 7 cases of 16 with rectal surgery.  All SSIs were classified as superficial SSIs.  The distance between the surgical wound and the stoma on the 1^st post operation day was 4.9 ± 1.1cm in the non-SSI group and 5.6 ± 0.8cm (p=0.08) in the SSI group.  On post operation day 3 the distance changed to 5.1 ± 1.3cm in the non-SSI group and 6.0±0.9cm (p=0.06) in the SSI group.

Conclusions: Our findings show that the incidence of SSI in this study was higher than data reported by both NHSN and JHAIS.  This outcome was the result of differences between the surveillance targets of the NHSN and JHAIS reports which included both stoma surgery and other types of surgery.  This study focused, however, specifically on stoma surgery.  Thus it appears as though ostomy surgery tends to be associated with a much higher risk of SSI than other types of surgery.  There were no significant statistical outcomes from the comparison of the distances between the stoma and surgical wound.  The findings demonstrate, thought, that the distance from the newly created stoma to the surgical wound of the SSI group tended to be farther than that of the non-SSI group.