DOI: 10.1097/md.0000000000049462 ISSN: 0025-7974

Risk factors for postoperative abdominal infection of colorectal cancer: A systematic review based on the PRISMA guidelines

Jie Zhang, Xiaodong Fan, Xingxing Xie
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Background:

Intra-abdominal infections are a common complication of colorectal cancer surgery. Postoperative abdominal infections can cause systemic inflammatory response syndrome, which seriously affects the prognosis of patients. With the widespread application of antibiotics, the detection rate of drug-resistant bacteria has increased annually, resulting in increased pressure on antibiotic treatment selection. To improve the prognosis of postoperative patients with colorectal cancer, it is important to actively search for risk factors leading to postoperative abdominal infection and formulate effective intervention measures according to these risk factors.

Methods:

A comprehensive search was conducted using several databases, including China National Knowledge Infrastructure, Wanfang Data, VIP, CBM, PubMed, Embase, and OVID, until September 2025. Case-control studies focusing on postoperative abdominal infections in colorectal cancer were conducted, and a meta-analysis was performed using the RevMan 5.4 software.

Results:

A total of 21 case-control studies were included, and 42 risk factors for infection were identified. The results indicated that significant differences ( P  < .05) existed between the postoperative abdominal infection and non-infection groups concerning various factors, including diabetes mellitus, hypertension, cardiovascular disease, hypoproteinemia, tumor-node-metastasis stage I, tumor location, and several perioperative variables: operation time exceeding 150 minutes, hospital stay of 30 days or more, drainage tube indentation lasting over 10 days, serum albumin levels, preoperative hemoglobin levels, incision length > 15 cm, blood loss exceeding 300 mL, laparoscopic surgery, postoperative fistula, preoperative intestinal obstruction, anemia, anastomotic fistula, combined organ resection, preoperative ASA score, perioperative blood transfusion, and reoperation.

Conclusion:

Given the multitude of identified risk factors for postoperative abdominal infections in colorectal cancer, medical institutions should prioritize the prevention and control of hospital infections. This includes developing targeted strategies based on identified risk factors, careful assessment of surgical indications for colorectal cancer patients during clinical diagnosis and treatment, strict adherence to surgical protocols, and enhancing organ function support for patients post-surgery to reduce the incidence of postoperative abdominal infections.

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