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
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 have a significantly higher infection rate due to:
- Large bacterial loads present in fecal matter
- Contamination of the peritoneal cavity
- Increased risk of anastomotic leakage
The infection rate of 30-40% in these cases is substantially higher than in clean or clean-contaminated procedures 1.
Anatomical Considerations and Risk Factors
The location of the resection anastomosis significantly impacts infection risk:
- Right colon: 17% leak rate
- Transverse colon: 25% leak rate
- Left colon: Up to 50% leak rate 1
These leak rates directly contribute to the high SSI rates observed in cases with fecal spillage, as anastomotic leaks further contaminate the surgical field.
Types of Surgical Site Infections
SSIs in these cases can be classified as:
- Superficial incisional infections (mortality rate: 4.2%)
- Deep incisional infections (mortality rate: 5.7%)
- Organ/space infections (mortality rate: 13.2%) 1
The overall case-fatality rate following gastrointestinal procedures is 7.2%, highlighting the serious nature of these infections 1.
Wound Management Techniques and Infection Rates
Different wound management approaches yield varying infection rates:
- Primary closure: 37% infection rate
- Delayed primary closure: 17% infection rate
- Vacuum-assisted closure: 0% infection rate 1
This data strongly suggests that vacuum-assisted closure systems and closed-incision negative-pressure therapy (cINPT) with delayed closure should be considered for contaminated wounds with fecal spillage to reduce infection rates.
Common Pathogens
The most common pathogens isolated in SSIs after colorectal surgery include:
- Escherichia coli (most common)
- Pseudomonas aeruginosa
- Klebsiella pneumoniae
- Methicillin-resistant Staphylococcus aureus
- Other Enterobacteriaceae 2
Prevention Strategies
Key preventive measures include:
- Maintaining intraoperative normothermia
- Using wound edge protectors (particularly dual-ring protectors)
- Considering delayed primary closure for contaminated wounds
- Appropriate antibiotic prophylaxis
- Vigilant postoperative monitoring for at least 30 days 1
In summary, the correct answer is D. 30-40%, which represents the expected SSI rate in laparotomy with resection anastomosis and gross fecal spillage according to CDC guidelines.