Postoperative infectious complications in gastric and colorectal cancer patients: A multicenter prospective cohort study from China.

[BACKGROUND] Postoperative infectious complications are prevalent and associated with increased health care costs, prolonged hospitalization, and reduced quality of life. However, data characterizing these complications in patients with gastric and colorectal cancer remain limited. We used a multicenter database to evaluate infectious complications.

[METHODS] This study was conducted using data from the Prevalence of Abdominal Complications After GastroEnterological surgery (PACAGE) registry. The study included cases from December 2018 to December 2020. The Clavien-Dindo grading system was used to categorize infectious complications based on severity, and the analysis was further refined by anatomic site. A generalized linear mixed-effects model was employed to identify infectious risk factors, with adjustment for multicenter hierarchical clustering effects.

[RESULTS] Among 3,926 gastric and colorectal cancer surgeries, postoperative infectious complications occurred in 11.8% (462 of 3,926), with 2.2% (88 of 3,926) major infections. Intra-abdominal infections predominated (7.6%; 50.4% of all infections). Median hospitalization costs and postoperative stays increased with severity: $9,842.9 (interquartile range: $8,128.9-$12,415.5) and 8.0 days (7.0-10.0) for no complications; $13,298.0 ($10,574.7-$16,846.7) and 14.0 days (10.0-20.5) for minor infections; and $19,812.7 ($14,454.1-$27,374.6) and 25.0 days (19.0-37.8) for major infections. Major surgical incision infections incurred the highest incremental costs ($13,685.5, interquartile range: $5,676.5-22,610.8) and longest incremental postoperative stays (31.0 days, 13.0-52.0). Independent infectious risk factors included comorbidities, prolonged operative time, combine resection, intraoperative complications, and R1 resection margins.

[CONCLUSION] Major postoperative infections result in a 2-fold increase in hospitalization costs and a 3-fold prolongation of postoperative hospital stay. Intra-abdominal infections should be prioritized as a strategic focus for targeted prevention and control.