Approaching elective colorectal surgical site infections: benefits of percutaneous radio-guided drain placement versus surgical reintervention to control the focus of infection

Abstract

BACKGROUND: Surgical Site infections (SSI) are a common complication of any type of surgery, but especially relevant in colorectal surgery (where the incidence goes up to 35% infection rates), due to the clean-contaminated nature of the intervention. SSI have a great impact in healthcare as they are associated with higher risk of complications, mortality rates, re-admission rates and also increase the length of stay at the hospital of the patients that develop them. Some studies have analysed populations undergoing colon and rectal procedures to determine risk factors of SSI or current predictors of treatment failure. Even though there has been a lot of improvement in prevention of the SSI that has translated into a decrease of mortality rates, there are still an important subset of patients that end up developing an infection after surgery. Especially in the organ-space SSI, which usually needs direct drainage or manipulation of the focus of infection apart from the antibiotic therapy. The aim of the study is to compare the different approaches to resolve an organ-space SSI, once it has developed after an elective colorectal surgery to control the focus of infection: reintervention versus radio-guided drain placement. OBJECTIVE: The main objective is to compare the impact in mortality, re-admission rates and length of stay of both approaches (surgical re-intervention versus percutaneous radio-guided drain placement) and how they gain control over the focus of infection (via measurement of the “duration of the infection” with the help of serologic parameters such as APR). The evidence gathered may be used to elaborate surgical profiles as to reach optimization in the treatment of the colorectal organ-space surgical-site-infections. DESIGN AND SETTING: It is designed as a quasi-experimental study, open-label and multicentric, conducted in different hospitals of Catalonia, and with the objective of comparing the different approaches to solve an organ-space surgical site infection: surgical re-intervention versus percutaneous radio-guided drain placement. PARTICIPANTS AND METHODS: 170 participants will be enrolled using a non-probabilistic consecutive sampling, with a two-year time of recruiting process. The participants will be divided between the intervention and the control group according to a careful surgical and clinical examination of each case performed by the colorectal surgeons and the interventionism radiologist team. Data about length of stay, mortality rates, re-admission rates, duration of the infection will be evaluated 3 months after the intervention