Major abdominal surgery such as esophageal, gastric, liver, pancreatic, colorectal resections and aortic aneurysm repair causes high peri-operative morbidity and mortality in patients.1 During the last decades, several studies have indicated that low volume hospitals having a higher chance of morbidity and mortality.2 Therefore, centralization of major abdominal surgery has occurred in numerous countries in Europe in the past 10 years.3-6
The Netherlands started with centralization in 1997 although no change in referral patterns or a decrease in morbidity and mortality was shown during evaluations in 1999 and 2005.6,7 In 2004 the Dutch Healthcare Inspectorate initiated a programme to obtain better surgical results, which lead to a minimum volume per hospital of ten annual major abdominal surgeries in 2006. These minimum amounts of surgeries lead by consequence to centralization of major abdominal surgeries in the Netherlands.2 Several studies showed a decreased mortality due to centralization of major abdominal surgery.2,8 Based on these findings, which are in contrast to other previous Dutch nationwide evaluations, it appears that centralization of major abdominal surgery is finally succeeding.2,6,9
Due to both the relatively low rate of mortality in high volume hospitals (2-3%), and the diligent management of complications the rescue rate of major abdominal surgery is high. 10,11
According to Wouters et al. (2009) not only mortality should be examined but morbidity should also be taken into account when looking at centralization of major abdominal surgeries in the Netherlands.10 Unfortunately, the morbidity of major abdominal surgery is still a continuing problem and not well examined yet for different subgroups of major abdominal surgery. At the moment, the morbidity rate for surgical patients is still high even for high-volume hospitals, approximately 40%, which is mainly caused by infectious complications.12-18 Several postoperative infections; surgical site infections (SSI), representing up to 45% of all postoperative infections, is the most common, but also respiratory tract infections (14%), urinary tract infections (13%), intravascular catheter induced infections (14%), septicaemia (9’12%) and bacteraemia (0.2’3.2%) are important causes of postoperative morbidity. 1,19-25 Infectious complications have lessened with the advent of prophylactic antibiotics. Unfortunately, due to the presence of multi-resistant pathogens it is an increasing challenge to tackle infections complications these days.26 In addition, it is known that higher incidences of morbidity and consequently an increased hospital length of stay are also associated with multidrug-resistant bacteria.27
Surgical patients with infectious complications, with and without multidrug-resistant bacteria, are responsible for prolonged wound healing, disability, prolonged hospitalization, increased overall cost of hospital care and even death, and, since the patient’s quality of life can thus be affected or even permanently altered, leading to very high personal and economic costs.1,28-31 Therefore, it is important to gain insight in several aspects of infectious complications to prevent or minimize infectious complications as far as possible. Preventing or minimizing infectious complications is, hence, an important epidemiologic goal.1,28 Therefore, the objective of this study is to determine the incidence, risk factors, associated pathogens and resistance, and consequences of infectious complications after major abdominal surgery over the last 5 years at a large Dutch teaching hospital.
The theoretical and practical value of this study is that the results would be useful for internal quality control, and be used to revise local infection prevention and treatment protocols. Infectious complications of resections of six major abdominal organs will be studied and results will be analyzed with respect to bacterial cultures and antibiotic treatments used. Also results will be compared with those in literature, and serially analyzed over time to assess trends in incidence and risk factors, associated pathogens and resistance, and consequences of infectious complications after major abdominal surgery over the last 5 years.
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