Elsevier

Surgery

Volume 155, Issue 4, April 2014, Pages 675-681
Surgery

Original Communication
A prospective study on surgical-site infections in thyroid operation

https://doi.org/10.1016/j.surg.2013.12.002Get rights and content

Background

To evaluate the incidence and the microbe spectrum of surgical-site infections (SSIs) in patients undergoing elective thyroid operation and to develop a risk factor−based predictive model.

Methods

This prospective study included 6,778 consecutive patients who underwent thyroid operation at a single institution between 2007 and 2012. SSI was defined according to the Centers for Disease Control and Prevention. Regression models were fitted to evaluate risk factors for SSI. A predictive nomogram was constructed from relevant variables in the multivariable analysis. Discrimination and calibration of the nomogram were assessed.

Results

The cumulative incidence of SSI after 30 days was 0.49%. The median time from operation to SSI was 7 days (interquartile range, 4–10.5 days). SSI was classified as superficial incisional in 30 cases (93.8%), deep incisional in 1 case (3.1%), and organ/space in 1 case (3.1%). Staphylococcus aureus was the most common isolate. In multivariable analysis, duration of operation (P = .004) and American Society of Anesthesiologists' score (P = .031) were identified as independent risk factors for SSI. These variables formed the basis of a nomogram, which was validated internally by bootstrapping and reached a predictive accuracy of 70.1%. The calibration curve showed a good agreement between predicted probability and actual observation.

Conclusion

The cumulative incidence of SSI in thyroid operation is <0.5%. American Society of Anesthesiologists' score and the duration of operation are independent risk factors for SSI. Antibiotic prophylaxis may be considered for selected patients based on the individual risk profile.

Section snippets

Study design

This study accrued 6,784 consecutive patients who underwent thyroid surgery at the Department of Surgery at the Kaiserin-Elisabeth-Hospital, Vienna, Austria, between March 1, 2007, and October 31, 2012. During this period, the hospital participated in the German Nosocomial Infection Surveillance System (KISS) and collected prospective data on all patients undergoing surgery. Institutional review board approval was obtained. The current study includes the patients who underwent thyroid operation

Incidence of SSI

Patient characteristics are shown in Table I. In all, SSI occurred in 32 cases. The cumulative incidence of SSI after 5, 10, 20, and 30 days was 0.18%, 0.36%, 0.46%, and 0.49%, respectively (Fig 1). The median time from surgery to SSI was 7 days (IQR 4–10.5 days). Of the 32 SSI, 5 (15.6%) occurred during the hospital stay for surgery and 27 occurred after hospital discharge (84.4%). Of the latter group, 10 patients (37.0%) required re-admission to the hospital for a median of 6 days (IQR 3–11

Discussion

This study shows that the cumulative incidence of SSI is <0.5%. ASA score and the duration of operation are independent risk factors for SSI. The low incidence of SSI does not justify routine antibiotic prophylaxis, but it may be considered for selected patients based on the individual risk profile.

In our study, the incidence of SSI was 0.49% at 30 days. This rate is somewhat lower than the average rate reported in the literature (reviewed in Table IV). This may in part be attributed to the

Conclusions

The cumulative incidence of SSI in thyroid surgery is <0.5%. ASA score and the duration of operation are independent risk factors for SSI. Routine antibiotic prophylaxis is not recommended but may be considered for selected patients on the basis of our predictive model. External validation of the nomogram is advocated.

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