• Mike K Liang, Linda T Li, Andres Avellaneda, Jennifer M Moffett, Stephanie C Hicks, and Samir S Awad.
• Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Operative Care Line, Room 112, 2002 Holcombe Blvd, Houston, TX 77030, USA. ml3@bcm.edu
• JAMA Surg. 2013 Feb 1;148(2):183-9.

ImportanceSurgical site infection following stoma reversal (SR) poses a substantial burden to the patient and health care system. Its overall incidence is likely underreported and poorly characterized. Improving our understanding of surgical site infection following stoma reversal may help us identify methods to decrease this complication.ObjectiveTo evaluate the incidence of surgical site infection (SSI) and identify predictors of SSI following SR.DesignA review of computerized hospital records on SR performed from January 1, 2005, until February 27, 2011.SettingAn integrated medical system at the Michael E. DeBakey Veterans Affairs Medical Center.Participants And InterventionAll adults undergoing SR during the study period.Main Outcome MeasuresRates of SSI and characteristics of patients with and without SSI were compared. A logistic regression model was developed to identify predictors of SSI.ResultsOne hundred twenty-eight patients underwent SR; 46 patients (36.0%) had an SSI. In comparison with no SSI, the infection was associated with seromas (17.4% vs 2.4%, P = .004), fascial dehiscence (15.2% vs 2.4%, P = .01), intensive care unit admission (34.8% vs 17.1%, P = .03), increased hospital length of stay (20 vs 9 days, P = .02), readmission (32.6% vs 13.4%, P = .01), delayed wound healing (91 vs 66 days, P = .02), and reoperation (32.6% vs 13.4%, P = .01). On multivariate analysis, history of fascial dehiscence (odds ratio, 16.9; 95% CI, 1.94-387), colostomy (5.07; 2.12-13.0), thicker subcutaneous fat (2.02; 1.33-3.21), and black race (0.35; 0.13-0.86) were associated with incisional SSI. There was no significant difference in patient satisfaction or functional status in late follow-up (1-73 months).Conclusions And RelevanceSurgical site infection is common following SR and is associated with significant morbidity. Four factors are strongly associated with increased risk of SSI in SR: history of fascial dehiscence, thicker subcutaneous fat, colostomy, and white race. Patients with none of these risk factors had a 0% SSI risk; patients with all 4 risk factors had a 100% risk of SSI.

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