Role of intraoperative blood loss in predicting surgical site infections during rectal cancer surgery

Aim: Surgical site infections (SSIs) are common complications in colorectal cancer surgeries, with an even higher incidence of rectal cancer due to coloanal or colorectal anastomoses.SSIs have been linked to an increased risk of local recurrence.This study aims to evaluate the effect of IBL on SSI development in rectal cancer patients.Material and Methods: Patients aged 18-80 years who underwent elective surgery for Stage I-III rectal adenocarcinoma were included.Surgical procedures followed Total Mesorectal Excision (TME) principles, using either low anterior resection (LAR) with circular staplers or abdominoperineal resection (APR).ROC analysis was conducted to determine the optimal intraoperative blood loss (IBL) cutoff for SSI prediction.Univariate and multivariate Cox regression models were used to identify risk factors, with a p-value <0.05 considered statistically significant.Results: IBV was significantly higher in patients with vs. 78 [60-100], p < 0.001).ROC analysis determined the optimal IBV cut-off for SSI risk prediction (AUC: 0.719, 95% CI: 0.636-0.803,p = 0.042).Sensitivity was 73.9%, and specificity was 69.6% (p < 0.001).Multivariate analysis confirmed that high IBV (OR: 5.761, p < 0.001), laparoscopic surgery (OR: 0.067, p = 0.025), and anastomotic leaks (OR: 32.986, p < 0.001) were independent risk factors for SSI development.Discussion: Intraoperative blood loss (IBL) is a significant risk factor for SSI development in rectal cancer surgeries.IBL exceeding 110 mL increases SSI risk by fivefold.These results highlight the need for further prospective studies evaluating strategies and risk assessment models aimed at reducing SSI incidence in this patient population.