SURGICAL SITE INFECTIONS AND MORTALITY IN ELDERLY PATIENTS

Background: Surgical site infections (SSI) are the most common nosocomial infections the patients who underwent surgery, and associated with rised morbidity, mortality and with high medical costs. Many risk factors for surgical treatment in the elderly may facilitate the development of more complications such as infections, than the younger. 

Objective: In this study, we presented the characteristics and outcomes of surgical site infections in elderly patients over the age of 65 years. and determined the factors influencing the mortality in these elderly patients. 

Methods: This prospective observational study was performed between January 2009 and June 2010 in Mersin University, which is a 402-bed tertiary-care hospital in Turkey. The patients were older than 65 years who developed SSIs were included the study. For each patient, SSI diagnosis was performed using the CDC standardized criteria. SPPS 16 package program was used for statistical analysis.

Results: A total of 75 patients over the age of 65 years who developed SSIs were enrolled in the study. The mean age of the patients was 74.7±6.4 (65-92), 68% of the patients were male. SSIs categorization were 33.3% of the patients had superficial incisional site infection, 33.3% deep incisional and 33.3% organ space infections. The preoperative co-morbid conditions of patients were malignancies (46.6%), diabetes mellitus (33.3%), chronic obstructive lung disease (16%), chronic renal failure (6.6%). The majority of the patients were classified as ASA II and III (42% and 51%, respectively). The mean SOFAmax score was 2.24±0.8.Fifteen (20%) patients received emergency surgery, the rest of the patients were undergoing elective surgery. The most frequently performed procedures were general surgery (32%), followed by cardiovascular surgery (17%), urologic surgery (15%), orthopedic surgery (9%).One hundred microorganisms were isolated from 75 wounds infected patients. The most frequently isolated bacteria were Acinetobacter baumanni (n=24) followed by Pseudomonas aureginosa (n=23). The overall in-hospital mortality rate was 25.3%. Statistical analysis found that gastrointestinal surgery, organ/space infections, polimicrobiality and higher SOFA scores were significantly associated with hospital mortality (P=0.005, P=0.0001, P=0.047, P=0.0001). According to laboratory tests, higher Wight Blood Cell (WBC) and Neutrophil count, higher total bilirubin level and lower thrombocyte count and albumin levels significantly associated with hospital mortality (P=0.040, P=0.014, P=0.001, P=0.019, P=0.002).

Conclusions: Gastrointestinal surgery, organ/space infections, higher SOFA scores were significantly associated with hospital mortality in elderly patients with SSI. These patients should be monitored more closely in terms of WBC and neutrophil, thrombocyte count, total bilirubin level and albumin levels, and if necessary, early intervention should be done.