eP264 - Factors Predictive of Surgical Site Infection in Ulcerative Colitis and Crohn’s Disease

Purpose/Background: Surgical site infection (SSI) is one of the most frequent postoperative complications after colectomy, with increased rates being reported in patients with inflammatory bowel disease (IBD). We sought to investigate whether there are different risk factors for SSI after colectomy for patients with ulcerative colitis (UC) versus Crohn’s disease (CD) to better aid in risk stratification and direct recovery expectations.Methods/Interventions: All patients with UC or CD undergoing partial or total colectomy between 2006-2020 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Those undergoing ileal pouch-anal anastomosis were excluded. UC and CD were compared for pre- and intra-operative characteristics as well as postoperative outcomes using chi-squared tests for univariate analysis. A multivariate logistic regression was used to find predictors of SSI, which included any pre- or intra-operative variables with P < 0.2 as independent variables.Results/Outcomes: 27356 CD and 13143 UC patients underwent colectomy during the study period. CD patients were slightly younger with a median age of 40 years and interquartile range (IQR) of 29-54 versus 46 years (IQR 31-61) for UC (P < 0.0001). CD had lower median BMI (24.4 vs 25.5 kg/m2, P < 0.0001). More CD patients were female (54 vs 43%, P < 0.0001) and black (9 vs 5%, P < 0.0001). CD patients were more likely to be smokers (23 vs 7%) and have chronic wounds at time of surgery (3.4 vs 1.7%), and they were less likely to have diabetes (4 vs 9%), preoperative dyspnea (2.7 vs 4.9%), chronic obstructive pulmonary disease (1.7 vs 2.4%), hypertension (17 vs 24%), steroid therapy (54 vs 61%), malnutrition (9 vs 15%), bleeding disorder (2 vs 5%), and preoperative sepsis (3.7 vs 5.4%, P < 0.0001 for all). Fewer CD patients also required preoperative transfusion (1.3 vs 5.5%, P < 0.0001). Less than 1% of patients in both groups had preoperative ventilator dependence, ascites, congestive heart failure, renal failure, dialysis dependence, or disseminated cancer. More CD patients were American Society of Anesthesiologists (ASA) class 1 or 2 compared to UC (60 vs 49%, P < 0.0001). CD was less likely to undergo emergent surgery (5 vs 10%, P < 0.0001) but had more contaminated or dirty wounds (39 vs 33%, P < 0.0001). Fewer CD patients underwent total colectomy compared to UC (8 vs 38%), and, as expected, median operative time was shorter for CD: 155 (IQR 114-214) vs 203 (IQR 153-269) minutes (P < 0.0001). CD had shorter lengths of stay (LOS) with a median of 6 days (IQR 4-9) compared to 7 days for UC (IQR 4-13, P < 0.0001) and lower rate of reoperation (5.2 vs 7.6%, P < 0.0001). On multivariate analysis, the following preoperative factors were associated with increased SSI: BMI, smoking, dyspnea, steroid therapy, chronic wound, anemia requiring transfusion, sepsis, and higher ASA class. Intraoperatively, emergent surgery, wound class, and operative time were predictive of increased SSI. The UC or CD diagnoses were not in of themselves predictive of increased risk for SSI.Conclusion/

Discussion: Many perioperative risk factors increase the likelihood of SSI for IBD patients undergoing colectomy. BMI and smoking are modifiable factors that increase SSI risk for both groups and should be optimized prior to surgery. Awareness of these findings and addressing potential factors associated with higher SSI will help optimize outcomes.Multivariate Regression on SSI for IBD PatientsPerioperative factors predictive of increased SSI. Included in multivariate model but not shown: age, gender, race, diabetes, ventilator dependence, chronic obstructive pulmonary disease, ascites, congestive heart failure, hypertension, chronic kidney disease, chronic wound, hypercoagulability