Impact of surgical site infection (SSI) following gynaecological cancer surgery in the UK: A trainee-led multicentre audit and service evaluation

Rachel L. O'Donnell, Georgios Angelopoulos, James P. Beirne, Ioannis Biliatis, Helen Bolton, Melissa Bradbury, Elaine Craig, Ketan Gajjar, Michelle L. Mackintosh, Wendy Macnab, Thumuluru Kavitha Madhuri, Mark McComiskey, Eva Myriokefalitaki, Claire L. Newton, Nithya Ratnavelu, Sian E. Taylor, Amudha Thangavelu, Sarah A. Rhodes, Emma J. Crosbie, Richard J. EdmondsonYee Loi Louise Wan*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)
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Abstract

Objectives 

Surgical site infection (SSI) complicates 5% of all surgical procedures in the UK and is a major cause of postoperative morbidity and a substantial drain on healthcare resources. Little is known about the incidence of SSI and its consequences in women undergoing surgery for gynaecological cancer. Our aim was to perform the first national audit of SSI following gynaecological cancer surgery through the establishment of a UK-wide trainee-led research network. 

Design and setting 

In a prospective audit, we collected data from all women undergoing laparotomy for suspected gynaecological cancer at 12 specialist oncology centres in the UK during an 8-week period in 2015. Clinicopathological data were collected, and wound complications and their sequelae were recorded during the 30 days following surgery. 

Results 

In total, 339 women underwent laparotomy for suspected gynaecological cancer during the study period. A clinical diagnosis of SSI was made in 54 (16%) women. 33% (18/54) of women with SSI had prolonged hospital stays, and 11/37 (29%) had their adjuvant treatment delayed or cancelled. Multivariate analysis found body mass index (BMI) was the strongest risk factor for SSI (OR 1.08[95% CI 1.03 to 1.14] per 1 kg/m 2 increase in BMI [p=0.001]). Wound drains (OR 2.92[95% CI 1.41 to 6.04], p=0.004) and staple closure (OR 3.13[95% CI 1.50 to 6.56], p=0.002) were also associated with increased risk of SSI. 

Conclusions 

SSI is common in women undergoing surgery for gynaecological cancer leading to delays in discharge and adjuvant treatment. Resultant delays in adjuvant treatment may impact cancer-specific survival rates. Modifiable factors, such as choice of wound closure material, offer opportunities for reducing SSI and reducing morbidity in these women. There is a clear need for new trials in SSI prevention in this patient group; our trainee-led initiative provides a platform for their successful completion.

Original languageEnglish
Article numbere024853
Number of pages8
JournalBMJ Open
Volume9
Issue number1
DOIs
Publication statusPublished - 24 Jan 2019

Keywords

  • gynaecological oncology
  • hospital acquired infection
  • noscomial infection
  • surgery
  • surgical site infection
  • wound management

ASJC Scopus subject areas

  • Medicine(all)

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    O'Donnell, R. L., Angelopoulos, G., Beirne, J. P., Biliatis, I., Bolton, H., Bradbury, M., Craig, E., Gajjar, K., Mackintosh, M. L., Macnab, W., Madhuri, T. K., McComiskey, M., Myriokefalitaki, E., Newton, C. L., Ratnavelu, N., Taylor, S. E., Thangavelu, A., Rhodes, S. A., Crosbie, E. J., ... Wan, Y. L. L. (2019). Impact of surgical site infection (SSI) following gynaecological cancer surgery in the UK: A trainee-led multicentre audit and service evaluation. BMJ Open, 9(1), [e024853]. https://doi.org/10.1136/bmjopen-2018-024853