What is the percentage of surgical site infection after laparotomy with resection anastomosis and gross fecal spillage?

Surgical Site Infection Rate After Laparotomy with Resection Anastomosis and Gross Fecal Spillage

The percentage of surgical site infection in a wound after laparotomy with resection anastomosis and gross fecal spillage is approximately 30-40% (option D). 1

Evidence for High Infection Rates in Contaminated Laparotomy Wounds

The World Journal of Emergency Surgery guidelines provide significant evidence regarding infection rates in contaminated surgical wounds:

• A Spanish randomized prospective study evaluated three techniques for wound management after laparotomy in contaminated and dirty/infected wounds (Class III or IV surgical wounds) 1
• Primary closure technique resulted in a 37% infection rate
• Delayed primary closure showed a 17% infection rate
• Vacuum-assisted closure demonstrated a 0% infection rate (though sample size was small) 1

When considering specifically laparotomy with resection anastomosis and gross fecal spillage, the contamination level is extremely high, placing these procedures in the dirty/infected wound category.

Risk Factors That Increase Infection Rates

Several factors contribute to the high infection rate in cases with fecal spillage:

• Gross fecal contamination introduces large bacterial loads directly into the surgical field 1
• Resection anastomosis procedures, particularly in the left colon, have higher leak rates (up to 50%) which further increases infection risk 2
• The Praxis Medical Insights data indicates that anastomotic leak rates vary by anatomical location:
  • Right colon: 17% leak rate
  • Transverse colon: 25% leak rate
  • Left colon: 50% leak rate 2

These leaks significantly contribute to the development of surgical site infections, particularly organ/space SSIs.

Classification of Surgical Site Infections

Surgical site infections are classified as:

• Superficial incisional (involving skin and subcutaneous tissue)
• Deep incisional (involving fascia and muscle layers)
• Organ/space infections (involving any part of anatomy manipulated during surgery) 1

In cases of fecal spillage during laparotomy, the risk for all types of SSIs increases dramatically, with particularly high rates of deep and organ/space infections.

Mortality and Morbidity Impact

The high infection rate in these cases correlates with significant mortality:

• Deep incisional SSIs have a mortality rate of 5.7%
• Organ/space SSIs have a mortality rate of 13.2%
• Following gastrointestinal procedures specifically, the case-fatality rate is 7.2% 1

Prevention Strategies

To reduce the extremely high infection rate (30-40%) in these cases:

• Consider vacuum-assisted closure techniques which have shown promising results in contaminated wounds 1
• Closed-incision negative-pressure therapy (cINPT) with delayed closure has demonstrated significant reduction in SSI rates (10.7% vs 63.2% with primary suturing) 1
• Maintain intraoperative normothermia, which has been shown to decrease SSI rates 1

Conclusion

Based on the most recent and highest quality evidence, particularly from the World Journal of Emergency Surgery guidelines, the surgical site infection rate after laparotomy with resection anastomosis and gross fecal spillage is in the range of 30-40%, making option D the correct answer. This high rate reflects the severe contamination present in these cases and underscores the importance of appropriate wound management techniques to reduce infection risk.