Surgical site infections and mortality in elderly patients.

OBJECTIVE: We present the characteristics and outcome of surgical site infections (SSI) in patients 65 years of age or more, and determine the factors influencing mortality.
METHODS: We conducted a prospective observational cohort study, comparing patients who survived with those who died, to identify risk factors associated with mortality among elderly patients presenting with SSI. The diagnosis of SSI was made for each patient, according to the CDC's standardized criteria.
RESULTS: Seventy-five patients presenting with SSI were included in the study. The mean age of patients was 75 ± 6 (65-92), 68% were male patients. The most frequently isolated pathogen was Acinetobacter baumannii (n = 24). The overall in-hospital mortality rate was 25.3%. The statistical analysis revealed that gastrointestinal surgery, organ/space infections, polymicrobial infections, and higher SOFA scores were significantly associated with hospital mortality (P = 0.005, P = 0.0001, P = 0.047, P = 0.0001). According to laboratory tests, higher white blood cell (WBC) and neutrophil count, higher total bilirubin level, and lower thrombocyte count and albumin levels were significantly associated with hospital mortality (P = 0.040, P = 0.014, P = 0.001, P = 0.019, P=0.002). Multivariate analyses revealed that serum albumin (P = 0.004, OR = 11.3, CI 95% 2.16-59.07), organ/space SSI (P = 0.0001, OR = 11.65, CI 95% 3.003-45.21), and SOFA score (P = 0.030, OR = 2.742, 1.100-6.84) were independent risk factors associated with mortality.
CONCLUSIONS: Serum albumin levels, organ/space infections, and higher SOFA scores were independently significantly associated with hospital mortality in older patients with SSI. Serum albumin levels should be closely monitored, and if necessary, early surgery should be performed.