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MP23-11: SURGICAL SITE INFECTION AFTER RADICAL CYSTECTOMY – INCIDENCE AND RISK FACTORS

Saturday, May 13
7:00 AM - 9:00 AM
Location: BCEC: Room 151

Presentation Authors: Hanan Goldberg*, Toronto, Canada, Chen Shenhar, Roy Mano, Jack Baniel, Daniel Kedar, David Margel, Ofer Yosseopowitch, Petach Tiqva, Israel

Introduction: Radical cystectomy with urinary diversion is the primary treatment for muscle invasive bladder cancer. The prevalence of postoperative complications, including surgical site infections (SSI), remains high. Complying with the enhanced recovery after surgery preoperative clinical pathway recommendations, we have modified our traditional preoperative cystectomy pathway, abandoning bowel preparation and changing the antibiotics regimen (supplanting intravenous ampicillin, gentamycin and metronidazole for a single dose of intravenous ceftriaxone). Concurrently, an increased rate of SSI was observed.
We thus sought to analyze our contemporary SSI rate after radical cystectomy and analyze its associated risk factors.


Methods: We queried our prospectively assembled radical cystectomy database to retrieve 287 patients operated between 2004 and .2014. Patients' medical records were reviewed for SSI as defined by the CDC guidelines published in 1999, namely, wound infection within the first postoperative month associated with either a) purulent discharge (with or without a positive wound culture), or b) pain, local erythema and swelling requiring wound drainage. Putative predictors of SSI were assessed by univariate and multivariate analyses.

Results: Of the 287 patients, 62 (22%) were diagnosed and treated with SSI, 48 (77%) of whom had a positive wound culture. In 32 patients (67%) the isolated pathogen was resistant to the administered perioperative antibiotic. Table 1 represents the univariate and multivariate analyses evaluating risk factors for SSI. Older age, presence of diabetes, treatment with neoadjuvant chemotherapy and surgery duration did not increase the probability of SSI, whereas higher BMI, ileal conduit (versus orthotopic) diversion and contemporary surgery during the recent years were associated with higher SSI prevalence.

Conclusions: Overall, a fifth of the patients undergoing radical cystectomy in our center developed SSI. These findings might reflect the increasing number of morbid and complex patients undergoing radical cystectomy in our center during recent years.

Source Of Funding: None

Hanan Goldberg, MD

Princess Margaret Hospital, University Health Network, University of Toronto

Dr. Hanan Goldberg, Uro-Onclogy fellow at Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada.
Current MSc. candidate in Clinical Epidemiology Master's program at the University of Toronto.
In 2016 I finished my Urology residency in Rabin Medical Center, Tel-Aviv University affiliated hospital, in Petach Tiqva, Israel.

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