Incidence of surgical site infection and associated risk factors in patients undergoing nephrectomy: A prospective cohort study.
Abstract
Background
Surgical site infection are among the most common healthcare-associated infections in Spain, contributing to increased morbidity, longer hospital stays, and higher associated costs. The objective of this study was to estimate the incidence of surgical site infection and identify risk factors in patients undergoing nephrectomy, with a focus on patient safety and quality improvement in surgical care.
Methods
A prospective cohort study was conducted from 2009 to 2023 at the University Hospital Alcorcón Foundation, including patients undergoing nephrectomy with a 30-day postoperative follow-up. Variables studied included demographic, clinical, surgical and prophylactic factors. Data were analyzed using descriptive statistics, bivariate tests, and a multivariate logistic regression model was built to identify independent risk factors for infection.
Results
A total of 468 patients (482 procedures) were included. The difference represents 14 patients undergoing subsequent contralateral or completion nephrectomies, each treated as an independent event. Most surgeries were elective (95.5%), clean-contaminated (92.1%), and laparoscopic (59.5%). The overall surgical site infection incidence was 4.8% (n=23). In the bivariate analysis, laparoscopic surgery was associated with a significantly lower risk of infection compared to open surgery (OR 0.29; 95% CI: 0.12-0.73; p=0.008). In multivariate model, partial nephrectomy (OR 0.22, 95% CI: 0.07-0.69; p=0.009) was identified as a protective factor, whereas incorrect antibiotic prophylaxis (OR 7.29, 95% CI: 1.03-51.83; p=0.047) and a National Healthcare Safety Network risk index of 3 (OR 94.53, 95% CI: 4.45-2006.17; p=0.004) were significantly associated with increased risk. The most frequently isolated microorganisms were Escherichia coli and Enterococcus faecium. Patients with surgical site infection had longer hospital stays (median 16 vs. 5 days).
Conclusions
Surgical site infection risk after nephrectomy showed a low incidence (4.8%). Partial nephrectomy has a lower risk than radical procedures. Appropriate antibiotic prophylaxis and risk stratification using the NHSN index are associated with a reduced risk of infection, and may improve patient safety and quality of care.