IMPACT OF SURGICAL SITE INFECTION ON IN-HOSPITAL MORTALITY IN PATIENTS UNDERGOING ELECTIVE COLORECTAL P0642 SURGERY: A MULTICENTER PROSPECTIVE COHORT STUDY e-mail: [email protected] E Shaw 1, A Gomila 1, M Piriz 2, F Obradors 3 , R Vazquez 4, JM Badia 4, L Martin 5, D Fraccalvieri 1, M Brugués 6, C Nicolas 7, E Espejo 8, A Castro 9, V Diaz-Brito 10 , E Limón 11 , J Carratalà 1, F Gudiol 11 , M Pujol 1 on behalf of VINCAT Programme. Catalonia. Spain 1Hospital Universitari de Bellvitge 2Hospital Parc Taulí 3Fundació Althaia de Manresa 4Fundació Hospital Asil de Granollers 5Hospital de Viladecans 6Consorci Sanitari de l’Anoia, 7Hospital Universitari Mútua de Terrassa 8Consorci Sanitari de Terrassa 9Hospital Universitari Sant Joan de Reus 10 Parc Sanitari Sant Joan de Déu 11 VINCat Programme. Departament de Salut. Catalonia. Spain INTRODUCTION AND PURPOSE METHODS Surgical site infection (SSI) in patients undergoing elective colorectal surgery increases morbidity and costs, We selected a sample of 10 hospitals of different size which provided data to the nosocomial infection although its influence on in-hospital mortality has been poorly explored. Despite mortality rates associated surveillance programme (VINCat Programme) of Catalonia between January 2012 to June 2014. For the with this complication is low, available data suggest that SSI is a predictor of mortality independently of NNIS current analysis, SSI was classified in 2 categories, incisional (superficial and deep) and organ/space risk index or other survival predictors such as laparoscopic surgery infection, both defined according to CDC’s definitions

Considering that colorectal surgery is associated with the highest rates of hospital–acquired infections, the After surgery, all patients were followed until discharge or death. During follow-up the development of SSI present study aims to assess the impact of SSI on in-hospital mortality in a current cohort of adults who was recorded. Those who remained hospitalised after 30 days of surgery without developing a SSI were underwent elective colorectal surgery in Catalonia, Spain censored. The main outcome was in-hospital mortality. To estimate risk factors associated with mortality we considered time-to-death, therefore, we used a Cox proportional hazard model to control for confounders RESULTS CONCLUSIONS A total of 2,276 patients underwent elective colorectal surgery, 276 (12%) had SSI during hospitalisation,122 incisional and 154 organ/space. At the end of follow -up, 2,156 (94 .7%) patients had been discharged, 99 (4.3%) remained hospitalised and 21 (1%) died . See table 1 and 2 and Figure 1 for further details . The mortality rate in patients undergoing elective Table 1 Table 2 colorectal surgery was low. However, organ/space Characteristics and outcome of patients according to infection status Risk factors associated with in-hospital mortality infection was an independent risk factor along with age. Non–SSI SSI HR (95%CI) HR (95%CI) N=2,000 N= 276 P N (%) N (%) unadjusted adjusted The daily risk of in-hospital mortality in patients with an Figure 1 Age, y median (IQR) 69 (60-77) 71 (61-79) 0.1 Age, y 1.07 (1.02-1.13) 1.09 (1.03-1.15)* organ/space infection was 3 times higher than in those Sex, male 1,194 (60) 208 (75%) <.001 Status at end of follow up of patients with SSI who did not develop it. Therefore, strategies to prevent Sex, male (vs female) 2.53 (0.74-8.62) --- Discharged Death Still admitted this serious complication are urgently needed Type of surgery <.001 Type of surgery Colon 1,383 (69) 162 (59) Organ/space SSI 87 12 55 Rectal (vs colon) 0.94 (0.39-2.27) --- REFERENCES Rectal 617 (31) 114 (41) • Astagneau P et al. Morbidity and mortality associated with surgical site infections: results from Adequate prophylaxis 1,619 (83) 213 (82) 0.6 Laparoscopic procedure (yes) 0.97 (0.41-2.28) --- the 1997-1999 INCISO Surveillance. J Hosp Infect 2001 • Kang CY et al. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Laparoscopic procedure 1,319 (66) 136 (49) <.001 NNIS risk index ≥ 1 (yes) 1.41 (0.59-3.36) --- inpatient sample 2009. Am J Surg 2012 • Billeter AT et al. Mortality after elective colon resection: the search for outcomes that define quality in surgical practice. J Am Coll Surg 2012 NNIS risk index ≥ 1 651 (33) 133 (48) <.001 Incisional SSI 103 2 17 SSI * • Horan TC et al. CDC definitions of nosocomial surgical site infections,1992: a modification of CDC definitions of Surgical wound infections. Am J Infect Control 1992. Length of stay, 7 (5-10) 21 (15-31) <.001 Organ/spaceIncisional (vs non-infection) 1.143.73 (0.23-5.60)(1.22-9.27) 1.444.40 (0.(1.61-12.0)* 29-7.04) median(IQR) Disclosures: authors declare none

Data are given as numbers (%) unless otherwise indicated. * P< .005 . Cox regression (forward stepwise method) Chi-squareIn-hospital or non-parametric mortality test were used to assess diffe 7rences (0.4) among groups 14 (5.1) <.001