ArticleThe journal of trauma and acute care surgery2021
Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties.
Article in The journal of trauma and acute care surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Systematic review and meta-analysis of outcomes associated with incisional and organ/space surgical site infections in abdominal surgery patients.Antimicrobial resistance and infection control · 2025Pooled it
- Are Fewer Damage Control Laparotomies Associated with a Decrease in the Rate and Severity of Surgical Site Infections?Surgical infections · 2026Article
- Damage control surgery in large-scale combat operations: still a life-saving strategy or a bridge to nowhere?Trauma surgery & acute care open · 2026Article
- Impact of Intra-Operative Shock and Resuscitation on Surgical Site Infections After Trauma Laparotomy.Surgical infections · 2024Article
- Identification of predictive factors for surgical site infections in gastrointestinal surgeries: A retrospective cross-sectional study in a resource-limited setting.F1000Research · 2023Article
- Anastomotic Outcomes in Military Exploratory Laparotomies in the Modern Combat Era.The American surgeon · 2022Article
- Study on Risk Factors and Nutritional Status of Postoperative Infection in Patients Undergoing Abdominal Surgery.Contrast media & molecular imaging · 2022Article
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSurgical site infections (SSIs) are well-recognized complications after exploratory laparotomy for abdominal trauma; however, little is known about SSI development after exploration for battlefield abdominal trauma. We examined SSI risk factors after exploratory laparotomy among combat casualties.
methodsMilitary personnel with combat injuries sustained in Iraq and Afghanistan (June 2009 to May 2014) who underwent laparotomy and were evacuated to participating US military hospitals were included. Log-binominal regression was used to identify SSI risk factors.
resultsOf 4,304 combat casualties, 341 patients underwent a total of 1,053 laparotomies. Abdominal SSIs were diagnosed in 49 patients (14.4%): 8% with organ space SSI, 4% with deep incisional SSI, and 4% with superficial SSIs (4 patients had multiple SSIs). Patients with SSIs had more colorectal (p < 0.001), small bowel (p = 0.010), duodenum (p = 0.006), pancreas (p = 0.032), and abdominal vascular injuries (p = 0.040), as well as prolonged open abdomen (p = 0.004) and more infections diagnosed before the SSI (or final exploratory laparotomy) versus non-SSI patients (p < 0.001). Sustaining colorectal injuries (risk ratio [RR], 3.20; 95% confidence interval [CI], 1.58-6.45), duodenum injuries (RR, 6.71; 95% CI, 1.73-25.58), and being diagnosed with prior infections (RR, 10.34; 95% CI, 5.05-21.10) were independently associated with any SSI development. For either organ space or deep incisional SSIs, non-intra-abdominal infections, fecal diversion, and duodenum injuries were independently associated, while being injured via an improvised explosive device was associated with reduced likelihood compared with penetrating nonblast (e.g., gunshot wounds) injuries. Non-intra-abdominal infections and hypotension were independently associated with organ space SSIs development alone, while sustaining blast injuries were associated with reduced likelihood.
conclusionDespite severity of injuries and the battlefield environment, the combat casualty laparotomy SSI rate is relatively low at 14%, with similar risk factors and rates reported following severe civilian trauma. LEVEL OF EVIDENCE: Epidemiological, level III.
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