EC Gastroenterology and Digestive System

Background: Surgical site infections (SSIs) remain a major complication following colonic surgery, contributing to increased morbidity, prolonged hospitalization, and healthcare costs. Identifying the prevalence and risk factors for SSIs is critical, particularly in resource-limited settings such as the Gaza Strip, where emergency surgeries are common and perioperative resources are constrained.

Methods: A cross-sectional study was conducted from March to September 2023 at Shifa Medical Complex, Gaza Strip. A total of 434 adult patients who underwent colonic surgery were included. Data on demographics, comorbidities, operative variables, and postoperative outcomes were collected using structured medical record abstraction and patient interviews. SSIs were classified according to CDC criteria. Descriptive statistics characterized the sample, and multivariate logistic regression identified independent risk factors associated with SSIs.

Results: The overall prevalence of SSIs was 25.1%. Significant patient-related risk factors included advanced age (≥ 55 years), obesity, and diabetes mellitus. Procedure-related factors significantly associated with SSIs were emergency surgery, open surgical approach, prolonged operative duration (≥ 150 minutes), high wound contamination, and delayed antibiotic prophylaxis (> 60 minutes before incision). Post-discharge surveillance revealed that approximately one-third of SSIs occurred after hospital discharge. Multivariate analysis confirmed diabetes, emergency surgery, delayed prophylaxis, and wound contamination as independent predictors of SSI (p < 0.05).

Conclusion: SSIs following colonic surgery are common in the Gaza Strip, driven by both patient and procedural factors. Targeted interventions, including strict glycemic control, timely antibiotic administration, adoption of minimally invasive techniques, and enhanced post-discharge surveillance, are recommended to reduce SSI incidence and improve surgical outcomes in resource-limited settings.

 Keywords: Surgical Site Infection; Colonic Surgery; Risk Factors; Gaza Strip

1. Baojun Duan., et al. “Colorectal Cancer: An Overview”. (2022): 1-12.
2. Shiekhah MA., et al. “General insight into cancer: An overview of colorectal cancer (Review)”. Molecular and Clinical Oncology 6 (2021): 271.
3. Rai HM. “Cancer detection and segmentation using machine learning and deep learning techniques: A review”. Multimedia Tools and Applications 83 (2024): 27001-27035.
4. Mármol I., et al. “Colorectal carcinoma: A general overview and future perspectives in colorectal cancer”. International Journal of Molecular Sciences 1 (2017): 197.
5. Joseph CA and Douglas JR. “Colorectal cancer screening and computerized tomographic colonography”. Berlin/Heidelberg: Springer (2013): 1-28.
6. Ivy B., et al. “Colorectal cancer: An overview of the epidemiology, risk factors, symptoms, and screening guidelines”. MEDSURG Nursing 1 (2007): 46-52.
7. Juan José G-R., et al. “Colorectal cancer: A review”. International Journal of Research in Medical Sciences 11 (2017): 4667.
8. Wilmink ABM. “Overview of the epidemiology of colorectal cancer”. Diseases of the Colon and Rectum 4 (1997): 483-493.
9. Surya KD. “Fundamentals of cancer detection, treatment, and prevention”. Hoboken, NJ: Wiley (2022): 193-217.
10. Antonio J. “Colorectal cancer: An introduction”. Rad Hrvatske Akademije Znanosti i Umjetnosti. Medicinske Znanosti (2015): 81-86.
11. Salgado-Nesme N., et al. “Usefulness of a circumferential wound retractor in emergency colorectal surgery as a preventive measure for surgical site infection. Alexis O-Ring^® and emergency surgery”. Revista Portuguesa de Pneumologia 4 (2020): 399-403.
12. Yosef N., et al. “Novel Clean Cision irrigating wound retractor vs standard Alexis wound retractor in the prevention of surgical site infection after colorectal resection”. Journal of the American College of Surgeons 5 (2022): S10.
13. Hussam N., et al. “SP9.2.3 Role of single or double ringed circumferential wound protectors in reducing surgical site infections following colorectal resections: An evidence synthesis by the meta-analysis of randomized controlled trials”. British Journal of Surgery S5 (2022): znac247-106.
14. Nakamura T., et al. “Risk factors for wound infection after laparoscopic surgery for colon cancer”. Surgical Laparoscopy Endoscopy and Percutaneous Techniques 1 (2020): 45-48.
15. Amri R., et al. “Risk stratification for surgical site infections in colon cancer”. JAMA Surgery 7 (2017): 686-690.
16. Fujii T., et al. “Effects of subcutaneous drain for the prevention of incisional SSI in high-risk patients undergoing colorectal surgery”. International Journal of Colorectal Disease 9 (2011): 1151-1155.
17. Bong JW., et al. “Nomogram for predicting the overall survival of underweight patients with colorectal cancer: A clinical study”. BMC Gastroenterology1 (2023): 39.
18. Manabu K., et al. “Underweight status predicts a poor prognosis in elderly patients with colorectal cancer”. Molecular and Clinical Oncology 3 (2016): 289-294.
19. Tyler SW., et al. “The obese colorectal surgery patient: Surgical site infection and outcomes”. Diseases of the Colon and Rectum 8 (2018): 938-945.
20. David WL., et al. “Additional value of preoperative albumin for surgical risk stratification among colorectal cancer patients”. Annals of Nutrition and Metabolism 6 (2020): 422-430.
21. Zuzana A. “Surgical site infection after surgery for colorectal cancer”. Kolor Kanserlerin Cerrahi Tedavisinde Cerrahi Enfeksiyonlar 8 (2015): 7-12.
22. Cristina ME., et al. “Malnutrition and increased risk of adverse outcomes in elderly patients undergoing elective colorectal cancer surgery: A case-control study nested in a cohort”. Nutrients1 (2022): 207.
23. Takatoshi N and Masahiko W. “Risk factors for wound infection after surgery for colorectal cancer: A matched case-control study”. InTech Rijeka, Croatia (2012).
24. Yu-Wei WC., et al. “Abdominal wall thickness is a predictor for surgical site infections in patients undergoing colorectal operations”. American Surgeon 7 (2021): 1155-1162.
25. Steffen A., et al. “Impact of preoperative body mass index and weight loss on morbidity and mortality following colorectal cancer-A retrospective cohort study”. International Journal of Colorectal Disease 9 (2022): 1983-1995.
26. Aquina CT., et al. “Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery”. Diseases of the Colon and Rectum 2 (2015): 220-227.
27. Sakai T., et al. “Visceral fat volume and surgical outcomes of colorectal resection”. International Surgery 4 (2009): 370-372.
28. Panos G., et al. “Risk of surgical site infections after colorectal surgery and the most frequent pathogens isolated: A prospective single-centre observational study”. Medicinski Glasnik 2 (2021): 438-443.
29. Kamboj M., et al. “Risk of surgical site infection following colorectal resection is higher in patients with disseminated cancer: An NCCN member cohort study”. Infection Control and Hospital Epidemiology 5 (2018): 555-562.
30. Mu Y., et al. “Improving risk-adjusted measures of surgical site infection for the national healthcare safety network”. Infection Control and Hospital Epidemiology 10 (2011): 970-986.