Surgical Site Infection Rate After Laparotomy with Resection Anastomosis and Fecal Spillage
The percentage of surgical site infection in a wound after laparotomy with resection anastomosis and fecal spillage is 30-40%. 1
Classification and Risk Factors
Surgical 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 a significantly higher risk of infection compared to clean or clean-contaminated wounds due to:
- Large bacterial loads from fecal contamination
- Contamination of the peritoneal cavity
- Potential for anastomotic leaks, which further increases infection risk
The presence of fecal spillage creates an environment highly conducive to bacterial growth and subsequent infection development. This is particularly concerning in laparotomy cases where the exposure is greater than in laparoscopic approaches, which have been shown to reduce SSI rates significantly (0.5% vs 1.8% in open procedures) 2.
Infection Types and Outcomes
Surgical site infections after laparotomy with fecal spillage can be classified as:
- Superficial incisional - affecting skin and subcutaneous tissue
- Deep incisional - affecting fascial and muscle layers
- Organ/space infections - affecting areas deep to the fascial layers
The deeper infections carry higher mortality rates, with deep incisional SSIs having a 5.7% mortality rate and organ/space infections having a 13.2% mortality rate 1.
Risk Modification Strategies
Several techniques can reduce the high infection rate associated with fecal spillage during laparotomy:
- Wound edge protectors (particularly dual-ring protectors) can reduce SSI rates (RR = 0.31) 1
- Maintaining intraoperative normothermia decreases SSI rates 1
- Vacuum-assisted closure systems have demonstrated significant reduction in SSI rates (infection rates of 0% compared to 37% with primary closure) 1
- Delayed primary closure should be considered for contaminated and dirty incisions (17% infection rate vs 37% with primary closure) 1
Anatomical Considerations
The location of resection and anastomosis affects the risk of leakage, which directly impacts infection rates:
- Right colon: 17% leak rate
- Transverse colon: 25% leak rate
- Left colon: up to 50% leak rate 1
Higher leak rates correlate with increased SSI risk, particularly in the left colon where fecal content is more solid and contains higher bacterial loads.
Conclusion and Answer
Based on the most recent and highest quality evidence from the CDC guidelines, the correct answer is:
D. 30-40% - This represents the expected surgical site infection rate after laparotomy with resection anastomosis and fecal spillage 1.