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Gerard R. Barber, RPh, MPH, CIC; Jeremy Miransky, PhD; Arthur E. Brown, MD; Daniel G. Coit, MD; Frank M. Lewis; Howard T. Thaler, PhD; Timothy E. Kiehn, PhD; Donald Armstrong, MD

Arch Surg. 1995;130(10):1042-1047.

Abstract
Objectives
To identify the rate of surgical site infection and risk factors for surgical site infection in patients with cancer and to evaluate antibiotic use patterns on surgical oncology services.

Design
Criterion standard.

Setting
Memorial Sloan-Kettering Cancer Center, a comprehensive cancer center at a university hospital.

Patients
Over a 15-month period, 1226 patients undergoing 1283 surgical procedures performed by the Breast, Colorectal, and Gastric-Mixed Tumor surgical services.

Main Outcome Measure
Direct observation of surgical sites was performed by a single, surgeon-trained member of the hospital's Infection Control Section, adhering to an established protocol for grading of the surgical site.

Results
Operative procedures accounted for the following traditional wound class distributions: class I (clean), 630 cases; class II (clean-contaminated), 577 cases; class III (contaminated), 29 cases; and class IV (dirty-infected), 47 cases. Surgical site infection rates were 3.8% in class I; 8.8% in class II; 20.7% in class III; and 46.9% in class IV procedures. The mean (±SD) age was 57.7±14.3 years and the Anesthesiology Society of America physical assessment score, 2.3±0.7. The mean (±SD) operation time was 145±104.9 minutes. Logistic regression analysis demonstrated several risk factors for surgical site infection: obesity (P<.0001); a contaminated or dirty-infected surgical procedure category (P<.0001); operation time greater than 4 hours (P=.0004); Anesthesiology Society of America physical assessment score of 3 or greater (P<.01); and preoperative length of stay of 3 or more days (P=.03).

Conclusions
Risk factors for surgical site infection in patients with cancer are similar to those found in the National Nosocomial Infections Surveillance System. However, as an individual risk factor among our patient population, obesity contributed as strongly as the surgical procedure category to a patient's likelihood of acquiring a surgical site infection. In addition to Anesthesiology Society of America status, length of the surgical procedure, and surgical procedure category, obesity should warrant consideration as an individual risk factor for surgical site infection.

(Arch Surg. 1995;130:1042-1047)

Author Affiliations
From the Infectious Disease Service, Department of Medicine (Mr Barber and Drs Brown, Kiehn, and Armstrong); Department of Quality Assessment (Dr Miransky and Mr Lewis); Gastric-Mixed Tumor Service, Department of Surgery (Dr Coit); and Department of Epidemiology and Biostatistics (Dr Thaler), Memorial Sloan-Kettering Cancer Center, New York, NY.

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