Trends in infectious complications after partial colectomy for colon cancer over a decade: A national cohort study

Published:October 26, 2022DOI:



      The American College of Surgeons National Surgical Quality Improvement Program helps participating hospitals track and report surgical complications with the goal of improving patient care. We sought to determine whether postoperative infectious complications after elective colectomy for malignancy improved among participating centers over time.


      Patients with colon malignancies who underwent elective partial colectomy with primary anastomosis (categorized as low or non-low) were identified from the American College of Surgeons National Surgical Quality Improvement Program database (2011–2019). Thirty-day postoperative infectious complications analyzed by year included superficial, deep, and organ space surgical site infections, urinary tract infection, pneumonia, and sepsis. Trends in patient and treatment characteristics were investigated using log-linear regression along with their association with infectious outcomes.


      Of the 78,827 patients identified, 51% were female, and the median age was 68. The majority (84%) underwent partial colectomy without a low anastomosis. There was a decrease in all infectious complications except for organ space infections which increased 35% overall from 2.0 to 2.7% (P = .037), driven by patients without a low anastomosis (1.9%–2.7%, P = .01). There was no change in most patient factors associated with organ space infections, except for a notable increase in American Society of Anesthesiologists class III and IV–V patients over time, both associated with organ space infections (P < .001; P = .002).


      Infectious complications have decreased significantly overall after colectomy for colon cancer, whereas there has been an increase in organ space infection rates specifically. Although changing patient characteristics may contribute to this observed trend, further study is needed to better understand its etiology to help mitigate this complication.
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        • Tevis S.E.
        • Kennedy G.D.
        Postoperative complications: looking forward to a safer future.
        Clin Colon Rectal Surg. 2016; 29: 246-252
        • Paulson E.C.
        • Thompson E.
        • Mahmoud N.
        Surgical site infection and colorectal surgical procedures: a prospective analysis of risk factors.
        Surg Infect (Larchmt). 2017; 18: 520-526
      1. Kalakouti E, Simillis C, Pellino G, et al. Characteristics of surgical site infection following colorectal surgery in a tertiary center: extended-spectrum β-lactamase-producing bacteria culprits in disease. Wounds. 12017;30:108–113.

        • Zywot A.
        • Lau C.S.M.
        • Stephen Fletcher H.
        • Paul S.
        Bundles prevent surgical site infections after colorectal surgery: meta-analysis and systematic review.
        J Gastrointest Surg. 2017; 21: 1915-1930
        • Sheka A.C.
        • Tevis S.
        • Kennedy G.D.
        Urinary tract infection after surgery for colorectal malignancy: risk factors and complications.
        Am J Surg. 2016; 211: 31-39
        • Regenbogen S.E.
        • Read T.E.
        • Roberts P.L.
        • Marcello P.W.
        • Schoetz D.J.
        • Ricciardi R.
        Urinary tract infection after colon and rectal resections: more common than predicted by risk-adjustment models.
        J Am Coll Surg. 2011; 213: 784-792
        • Holubar S.D.
        • Hedrick T.
        • Gupta R.
        • et al.
        American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery.
        Perioper Med (Lond). 2017; 6: 4
        • Vo E.
        • Massarweh N.N.
        • Chai C.Y.
        • et al.
        Association of the addition of oral antibiotics to mechanical bowel preparation for left colon and rectal cancer resections with reduction of surgical site infections.
        JAMA Surg. 2018; 153: 114-121
        • Leaper D.J.
        • Holy C.E.
        • Spencer M.
        • et al.
        Assessment of the risk and economic burden of surgical site infection following colorectal surgery using a US longitudinal database: is there a role for innovative antimicrobial wound closure technology to reduce the risk of infection?.
        Dis Colon Rectum. 2020; 63: 1628-1638
        • Gantz O.
        • Zagadailov P.
        • Merchant A.M.
        The cost of surgical site infections after colorectal surgery in the United States from 2001 to 2012: a longitudinal analysis.
        Am Surg. 2019; 85: 142-149
        • Zogg C.K.
        • Ottesen T.D.
        • Kebaish K.J.
        • et al.
        The cost of complications following major resection of malignant neoplasia.
        J Gastrointest Surg. 2018; 22: 1976-1986
        • Lohsiriwat V.
        • Jitmungngan R.
        Enhanced recovery after surgery in emergency colorectal surgery: review of literature and current practices.
        World J Gastrointest Surg. 2019; 11: 41-52
        • Hawkins A.T.
        • Geiger T.M.
        • King A.B.
        • et al.
        An enhanced recovery program in colorectal surgery is associated with decreased organ level rates of complications: a difference-in-differences analysis.
        Surg Endosc. 2019; 33: 2222-2230
        • Pop-Vicas A.E.
        • Abad C.
        • Baubie K.
        • Osman F.
        • Heise C.
        • Safdar N.
        Colorectal bundles for surgical site infection prevention: a systematic review and meta-analysis.
        Infect Control Hosp Epidemiol. 2020; 41: 805-812
        • American College of Surgeons (ACS)
        National surgical quality improvement program.
        Date accessed: April 4, 2022
        • American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)
        User guide for the 2019 participant use data file.
        • National Cancer Institute (NCI)
        Surveillance, Epidemiology, and End Results (SEER) Program. Joinpoint Trend Analysis Software 2021.
        Date: 2021
        Date accessed: May 6, 2022
        • Grass F.
        • Martin D.
        • Moulin E.
        • Hahnloser D.
        • Demartines N.
        • Hübner M.
        Specific national surveillance program for organ space infections after colonic surgery.
        Surg Infect (Larchmt). 2019; 20: 373-377
        • Chen M.
        • Song X.
        • Chen L.Z.
        • Lin Z.D.
        • Zhang X.L.
        Comparing mechanical bowel preparation with both oral and systemic antibiotics versus mechanical bowel preparation and systemic antibiotics alone for the prevention of surgical site infection after elective colorectal surgery: a meta-analysis of randomized controlled clinical trials.
        Dis Colon Rectum. 2016; 59: 70-78
        • Kiran R.P.
        • Murray A.C.
        • Chiuzan C.
        • Estrada D.
        • Forde K.
        Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery.
        Ann Surg. 2015; 262 (discussion 423ؘ425): 416-425
        • Midura E.F.
        • Jung A.D.
        • Hanseman D.J.
        • et al.
        Combination oral and mechanical bowel preparations decreases complications in both right and left colectomy.
        Surgery. 2018; 163: 528-534
        • Klinger A.L.
        • Green H.
        • Monlezun D.J.
        • et al.
        The role of bowel preparation in colorectal surgery: results of the 2012-2015 ACS-NSQIP data.
        Ann Surg. 2019; 269: 671-677
        • Tanner J.
        • Padley W.
        • Assadian O.
        • Leaper D.
        • Kiernan M.
        • Edmiston C.
        Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients.
        Surgery. 2015; 158: 66-77
        • Berenguer C.M.
        • Ochsner M.G.
        • Lord S.A.
        • Senkowski C.K.
        Improving surgical site infections: using National Surgical Quality Improvement Program data to institute Surgical Care Improvement Project protocols in improving surgical outcomes.
        J Am Coll Surg. 2010; 210 (737–741:741–743)
        • Aimaq R.
        • Akopian G.
        • Kaufman H.S.
        Surgical site infection rates in laparoscopic versus open colorectal surgery.
        Am Surg. 2011; 77: 1290-1294
        • Kiran R.P.
        • El-Gazzaz G.H.
        • Vogel J.D.
        • Remzi F.H.
        Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program.
        J Am Coll Surg. 2010; 211: 232-238
        • Poon J.T.
        • Law W.L.
        • Wong I.W.
        • et al.
        Impact of laparoscopic colorectal resection on surgical site infection.
        Ann Surg. 2009; 249: 77-81
        • Segal C.G.
        • Waller D.K.
        • Tilley B.
        • Piller L.
        • Bilimoria K.
        An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery.
        Surgery. 2014; 156: 1253-1260
        • Lawson E.H.
        • Hall B.L.
        • Ko C.Y.
        Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives.
        JAMA Surg. 2013; 148: 849-858
        • Kwag S.J.
        • Kim J.G.
        • Kang W.K.
        • Lee J.K.
        • Oh S.T.
        The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer.
        Ann Surg Treat Res. 2014; 86: 206-211
        • Choudhuri A.H.
        • Uppal R.
        • Kumar M.
        Influence of non-surgical risk factors on anastomotic leakage after major gastrointestinal surgery: audit from a tertiary care teaching institute.
        Int J Crit Illn Inj Sci. 2013; 3: 246-249
        • Suding P.
        • Jensen E.
        • Abramson M.A.
        • Itani K.
        • Wilson S.E.
        Definitive risk factors for anastomotic leaks in elective open colorectal resection.
        Arch Surg. 2008; 143 (discussion 911–912): 907-911
        • Awad S.
        • El-Rahman A.I.A.
        • Abbas A.
        • et al.
        The assessment of perioperative risk factors of anastomotic leakage after intestinal surgeries; a prospective study.
        BMC Surg. 2021; 21: 29
        • Borloni B.
        • Huettner H.
        • Schuerholz T.
        Preoperative nutritional conditioning: why, when and how.
        Visc Med. 2019; 35: 299-304
        • West M.A.
        • Wischmeyer P.E.
        • Grocott M.P.W.
        Prehabilitation and nutritional support to improve perioperative outcomes.
        Curr Anesthesiol Rep. 2017; 7: 340-349
        • van Rooijen S.
        • Carli F.
        • Dalton S.
        • et al.
        Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation.
        BMC Cancer. 2019; 19: 98
        • Fearon K.C.
        • Ljungqvist O.
        • Von Meyenfeldt M.
        • et al.
        Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection.
        Clin Nutr. 2005; 24: 466-477
        • Owen R.M.
        • Perez S.D.
        • Bornstein W.A.
        • Sweeney J.F.
        Impact of surgical care improvement project inf-9 on postoperative urinary tract infections: do exemptions interfere with quality patient care?.
        Arch Surg. 2012; 147: 946-953
        • Hendren S.
        Urinary catheter management.
        Clin Colon Rectal Surg. 2013; 26: 178-181
        • Schwenk W.
        • Böhm B.
        • Witt C.
        • Junghans T.
        • Gründel K.
        • Müller J.M.
        Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation.
        Arch Surg. 1999; 134 (discussion 13): 6-12
        • Chughtai M.
        • Gwam C.U.
        • Mohamed N.
        • et al.
        The epidemiology and risk factors for postoperative pneumonia.
        J Clin Med Res. 2017; 9: 466-475
        • Barbieux J.
        • Hamy A.
        • Talbot M.F.
        • et al.
        Does enhanced recovery reduce postoperative ileus after colorectal surgery?.
        J Visc Surg. 2017; 154: 79-85
        • Huo Y.R.
        • Phan K.
        • Morris D.L.
        • Liauw W.
        Systematic review and a meta-analysis of hospital and surgeon volume/outcome relationships in colorectal cancer surgery.
        J Gastrointest Oncol. 2017; 8: 534-546
        • American College of Surgeons National Surgical Quality Improvement Program
        User guide for the 2019 ACS NSQIP procedure targeted participantion use date files (PUF) 2019.
        Target colectomy. 2019; : 38-41