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%. 1
Classification and Infection Risk
Wounds with gross fecal spillage are classified as Class IV/Dirty-Infected wounds according to the Centers for Disease Control and Prevention (CDC) classification system. These wounds carry the highest risk of infection due to:
- Large bacterial loads present in fecal matter
- Extensive contamination of the peritoneal cavity
- Compromised local tissue defenses
The primary reason for this high infection rate is the significant bacterial contamination that occurs during the procedure, which overwhelms the body's natural defenses and antibiotic prophylaxis.
Factors Affecting Infection Rates
Several factors influence the high infection rate in these cases:
Anatomical location: Resection anastomosis procedures have varying leak rates depending on location:
- Right colon: 17% leak rate
- Transverse colon: 25% leak rate
- Left colon: Up to 50% leak rate 1
Wound management technique: Different approaches yield varying infection rates:
Technique Infection Rate Primary Closure 37% Delayed Primary Closure 17% Vacuum-Assisted Closure 0% 1
Prevention Strategies
To reduce the 30-40% infection rate in these high-risk cases, several evidence-based interventions can be implemented:
Wound edge protectors: Dual-ring protectors significantly reduce SSI rates (RR = 0.31) 1
Delayed primary closure: Should be considered for contaminated and dirty incisions with purulent contamination, with wound revision between 2-5 days postoperatively 1
Vacuum-assisted closure systems: These have demonstrated significant reduction in SSI rates, with some studies showing infection rates as low as 0% 1
Maintaining intraoperative normothermia: This decreases SSI rates as recommended by CDC guidelines 1
Clinical Implications
The high infection rate (30-40%) in these cases has significant clinical implications:
- Increased morbidity and mortality (deep incisional SSI: 5.7% mortality, organ/space SSI: 13.2% mortality) 1
- Prolonged hospital stays
- Higher healthcare costs
- Need for additional interventions
Common Pitfalls and Caveats
- Underestimating infection risk: Despite awareness of the high infection rate, studies show gaps in implementing preventive measures 2
- Delayed diagnosis: Most SSIs are diagnosed around 10 days after surgery, highlighting the importance of vigilant postoperative monitoring 1
- Laparoscopic vs. open approach: When feasible, laparoscopic approaches significantly reduce SSI rates compared to open procedures 3, 4
- Blood transfusion risk: Intra- or postoperative blood transfusions significantly increase SSI risk (1-3 units, OR = 5.3; ≥4 units, OR = 6.2) 5
Therefore, based on the most recent and highest quality evidence, the answer is D. 30-40%.