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Antibiotic Choice Is Independently Associated With Risk of Surgical Site Infection After Colectomy: A Population-Based Cohort Study

Hendren, Samantha MD, MPH*; Fritze, Danielle MD*; Banerjee, Mousumi PhD; Kubus, James MS*; Cleary, Robert K. MD; Englesbe, Michael J. MD*; Campbell, Darrell A. Jr MD*

doi: 10.1097/SLA.0b013e31826c4009
Original Articles

Objective: To determine which perioperative care practices are associated with decreased risk of surgical site infection (SSI) after colectomy surgery.

Background: Optimization of perioperative care has been a common strategy for improving surgical safety, but the relationship between process measure compliance and surgical complication rates is controversial.

Methods: This is a retrospective cohort study performed within the Michigan Surgical Quality Collaborative (MSQC), an organization of hospitals that prospectively collects patient data, processes of care, and 30-day outcomes. Patients undergoing colectomy surgery (n = 4331) were studied. Factors potentially associated with SSI were tested using univariate statistical tests, and a hierarchical generalized linear model was created to test for independent associations between processes of care and SSI, while adjusting for patient risk factors and clustering of patients within hospitals.

Results: Several perioperative care practices were independently associated with lower risk of SSI after adjustment for patient risk, procedure type/duration, and clustering of patients by hospital site. Best practices include selection of a Surgical Care Improvement Project (SCIP-2)-compliant prophylactic intravenous antibiotic, postoperative normothermia, postoperative day 1 glucose control, and oral antibiotics given when bowel prep used (SCIP-1 was not significant). Further, several specific prophylactic antibiotic choices were independently associated with lower SSI rates, including cefazolin/metronidazole, ciprofloxacin/metronidazole, and ertapenem.

Conclusions: In Michigan, several perioperative care practices are independently associated with decreased risk of SSI after colectomy, including SCIP-2-compliant prophylactic antibiotics, postoperative normothermia, glucose control, and oral antibiotics. Furthermore, specific prophylactic antibiotic choices are associated with lower risk of SSI. These results account for patient factors and unmeasured hospital effects, suggesting that dissemination of these perioperative care practices may decrease SSI rates.

A cohort study was performed in Michigan (n = 4331) to determine “best practices” for minimizing surgical site infection (SSI) after colectomy. Adjusting for patient risk, procedure type/duration, and clustering, lower SSI was found in patients receiving Surgical Care Improvement Project (SCIP-2)-compliant antibiotics, normothermia, glucose control, and Nichols prep. Several specific antibiotic choices were also associated with lower SSI rates.

*Department of Surgery, University of Michigan Health System, Ann Arbor, MI

Department of Biostatistics, University of Michigan, Ann Arbor, MI

Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI.

Reprints: Samantha Hendren, MD, MPH, General Surgery, Department of Surgery, University of Michigan Health System, 2124 Taubman Center, 1500 East Medical Center Drive, SPC-5343, Ann Arbor, MI 48109. E-mail:

Disclosure: This work was supported by Department of Surgery, University of Michigan. The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.