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. Edmondson; Yee Loi Louise Wan

doi:10.1136/bmjopen-2018-024853

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. Edmondson

Yee Loi Louise Wan^*

^*Corresponding author for this work

School of Medicine, Dentistry and Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

21 Citations (Scopus)

322 Downloads (Pure)

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 language	English
Article number	e024853
Number of pages	8
Journal	BMJ Open
Volume	9
Issue number	1
DOIs	https://doi.org/10.1136/bmjopen-2018-024853
Publication status	Published - 24 Jan 2019

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

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

ASJC Scopus subject areas

General Medicine

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10.1136/bmjopen-2018-024853Licence: CC BY

Impact of surgical site infection (SSI) following gynaecological cancer surgery in the UK: a trainee-led multicentre audit and service evaluation
Copyright 2019 the authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 316 KBLicence: CC BY

Cite this

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), Article e024853. https://doi.org/10.1136/bmjopen-2018-024853

@article{51d0003f49eb4c6cad3e1503f8cea875,

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

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.",

keywords = "gynaecological oncology, hospital acquired infection, noscomial infection, surgery, surgical site infection, wound management",

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

year = "2019",

month = jan,

day = "24",

doi = "10.1136/bmjopen-2018-024853",

language = "English",

volume = "9",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "1",

}

O'Donnell, RL, Angelopoulos, G, Beirne, JP, Biliatis, I, Bolton, H, Bradbury, M, Craig, E, Gajjar, K, Mackintosh, ML, Macnab, W, Madhuri, TK, McComiskey, M, Myriokefalitaki, E, Newton, CL, Ratnavelu, N, Taylor, SE, Thangavelu, A, Rhodes, SA, Crosbie, EJ, Edmondson, RJ & Wan, YLL 2019, 'Impact of surgical site infection (SSI) following gynaecological cancer surgery in the UK: A trainee-led multicentre audit and service evaluation', BMJ Open, vol. 9, no. 1, e024853. https://doi.org/10.1136/bmjopen-2018-024853

TY - JOUR

T1 - Impact of surgical site infection (SSI) following gynaecological cancer surgery in the UK: A trainee-led multicentre audit and service evaluation

AU - O'Donnell, Rachel L.

AU - Angelopoulos, Georgios

AU - Beirne, James P.

AU - Biliatis, Ioannis

AU - Bolton, Helen

AU - Bradbury, Melissa

AU - Craig, Elaine

AU - Gajjar, Ketan

AU - Mackintosh, Michelle L.

AU - Macnab, Wendy

AU - Madhuri, Thumuluru Kavitha

AU - McComiskey, Mark

AU - Myriokefalitaki, Eva

AU - Newton, Claire L.

AU - Ratnavelu, Nithya

AU - Taylor, Sian E.

AU - Thangavelu, Amudha

AU - Rhodes, Sarah A.

AU - Crosbie, Emma J.

AU - Edmondson, Richard J.

AU - Wan, Yee Loi Louise

PY - 2019/1/24

Y1 - 2019/1/24

N2 - 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.

AB - 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.

KW - gynaecological oncology

KW - hospital acquired infection

KW - noscomial infection

KW - surgery

KW - surgical site infection

KW - wound management

UR - https://www.scopus.com/pages/publications/85060510234

U2 - 10.1136/bmjopen-2018-024853

DO - 10.1136/bmjopen-2018-024853

M3 - Article

C2 - 30679297

AN - SCOPUS:85060510234

SN - 2044-6055

VL - 9

JO - BMJ Open

JF - BMJ Open

IS - 1

M1 - e024853

ER -

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

Abstract

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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