Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery

E. Shaw, A. Gomila, M. Piriz, R. Perez, J. Cuquet, A. Vazquez, J. M. Badia, A. Lérida, D. Fraccalvieri, A. Marron, N. Freixas, A. Castro, A. Cruz, E. Limón, F. Gudiol, S. Biondo, J. Carratalà, M. Pujol, D. Camprubí, L. MartínC. Sanz, M. Brugués, X. Serra-Aracil, L. Mora, V. Diaz-Brito, E. Moreno, F. Obradors, E. Espejo, F. Aguilar, L. Pagespetit, C. Nicolás, A. Navarro, R. Vazquez, N. Arroyo, A. F. López, S. Iftimie

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5 Citations (Scopus)

Abstract

© 2018 The Healthcare Infection Society Background: Accounting for time-dependency and competing events are strongly recommended to estimate excess length of stay (LOS) and risk of death associated with healthcare-associated infections. Aim: To assess the effect of organ/space (OS) surgical site infection (SSI) on excess LOS and in-hospital mortality in patients undergoing elective colorectal surgery (ECS). Methods: A multicentre prospective adult cohort undergoing ECS, January 2012 to December 2014, at 10 Spanish hospitals was used. SSI was considered the time-varying exposure and defined as incisional (superficial and deep) or OS. Discharge alive and death were the study endpoints. The mean excess LOS was estimated using a multistate model which provided a weighted average based on the states patients passed through. Multivariate Cox regression models were used to assess the effect of OS-SSI on risk of discharge alive or in-hospital mortality. Findings: Of 2778 patients, 343 (12.3%) developed SSI: 194 (7%) OS-SSI and 149 (5.3%) incisional SSI. Compared to incisional SSI or no infection, OS-SSI prolonged LOS by 4.2 days (95% confidence interval (CI): 4.1–4.3) and 9 days (8.9–9.1), respectively, reduced the risk of discharge alive (adjusted hazard ratio (aHR): 0.36 (95% CI: 0.28–0.47) and aHR: 0.17 (0.14–0.21), respectively), and increased the risk of in-hospital mortality (aHR: 8.02 (1.03–62.9) and aHR: 10.7 (3.7–30.9), respectively). Conclusion: OS-SSI substantially extended LOS and increased risk of death in patients undergoing ECS. These results reinforce OS-SSI as the SSI with the highest health burden in ECS.
Original languageEnglish
Pages (from-to)400-405
JournalJournal of Hospital Infection
Volume100
DOIs
Publication statusPublished - 1 Dec 2018

Keywords

  • Elective colorectal surgery
  • Length of stay
  • Mortality
  • Multistate modelling
  • Organ-space infection
  • Surgical site infection

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