New Insights into Risk Factors for Postoperative Infections in Colorectal Cancer

New Insights into Risk Factors for Postoperative Infections in Colorectal Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article New Insights into Risk Factors for Postoperative Infections in Colorectal Cancer Jia Li, Huacai Zhao, Jia Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4262701/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Postoperative incision infections are a significant concern in colorectal cancer surgery, impacting patient recovery and well-being. Identification of key risk factors for infection following colorectal cancer surgery is crucial for improving patient outcomes. Methods A meta-analytical approach was employed to analyze studies published from January 2015 to December 2022, focusing on variables such as body mass index, diabetes, albumin levels, malnutrition, and surgical duration to assess their association with postoperative infection incidence in colorectal cancer patients. Results Analysis of eleven high-quality studies revealed that elevated body mass index, diabetes, low albumin levels, malnutrition, and longer surgical durations were linked to an increased risk of postoperative incision infections. Conversely, laparoscopic procedures demonstrated potential for reducing infection risks. Conclusions Effective preoperative risk assessment and management are vital in preventing postoperative incision infections in colorectal cancer patients. These findings offer actionable insights for clinicians to optimize patient prognoses and enhance overall quality of life outcomes. Colorectal Cancer Postoperative Incision Infection Risk Factors Meta-Analysis Laparoscopic Surgery Patient Outcomes Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Colorectal cancer ranks among the malignancies with the highest incidence and mortality rates globally, particularly in developed countries [ 1 , 2 ]. As a significant type of gastrointestinal malignancy, colorectal cancer spreads through lymphatic and blood circulation, imposing significant physical and psychological burdens on patients [ 3 , 4 , 5 , 6 , 7 ]. According to recent cancer statistics, colorectal cancer ranks third in incidence and fifth in mortality among all cancers in China, with an annual report of 376,000 new cases and 191,000 deaths [ 8 , 9 , 10 ]. These figures highlight the substantial impact of colorectal cancer on individuals and society and underscore the importance of timely and effective diagnosis and treatment [ 11 , 12 , 13 ]. Clinically, surgical resection remains the mainstream treatment for colorectal cancer, with curative surgery being the standard treatment strategy [ 14 , 15 , 16 ]. Although such surgery can control disease progression to some extent, numerous studies have identified postoperative incision infection as a standard and severe complication, which, in severe cases, may lead to sepsis, systemic infection, and death [ 17 , 18 , 19 ]. Advances in medical technology have made laparoscopic surgery the preferred technique for treating colorectal cancer due to its minimally invasive nature, fewer complications, and faster postoperative recovery [ 20 , 21 , 22 , 23 , 24 ]. However, the risk of postoperative incision infection persists, affecting patient recovery speed, increasing treatment costs, and exacerbating the burden on healthcare resources [ 25 , 26 , 27 ]. Patients undergoing surgery for colorectal cancer face a heightened risk of postoperative incision infection due to the necessity for prolonged fasting and bowel preparation preoperatively and the potential for contamination of the surgical area by intestinal contents during surgery [ 28 , 29 , 30 ]. Furthermore, the invasion of pathogens directly causes these infections [ 31 ]. In China, the incidence of surgical site infections reaches as high as 1.01% [ 32 , 33 , 34 , 35 , 36 ], with rates in specific regions and populations potentially soaring to 20%, especially in resource-constrained developing countries [ 14 , 37 , 38 , 39 ]. Although extensive research has been conducted on the risk factors for postoperative incision infection in colorectal cancer, findings remain varied without a unified conclusion [ 40 , 41 , 42 ]. Factors such as age, medical history, and surgical duration are considered potential influencers of infection risk, yet their relative importance and interactions still need to be fully clarified [ 43 , 44 , 45 ]. Despite attempts to explore preventative measures, the effectiveness of prevention and treatment strategies requires further research due to issues like insufficient sample sizes and study design biases [ 46 , 47 , 48 ]. This study aims to provide a more precise risk assessment and effective prevention strategies for clinical application, thereby improving patient recovery quality and reducing associated medical costs through systematic analysis and meta-analysis of various risk factors for postoperative incision infection in colorectal cancer. Beyond focusing on the direct risk factors, this research also examines how optimizing preoperative preparation, improving surgical techniques, and enhancing postoperative management can effectively reduce the incidence of incision infection. The findings guide clinicians in devising individualized treatment plans, enhancing surgical safety, and improving patient quality of life. Additionally, reducing postoperative incision infections can significantly lower medical costs, alleviate the economic burden on patients and their families, and improve healthcare service quality and patient satisfaction. In summary, this study aims to create a safer and more effective surgical treatment environment for colorectal cancer patients through in-depth analysis and comprehensive evaluation. Materials and Methods Literature Source and Retrieval This study searched for risk factors associated with postoperative incision infection in colorectal cancer patients across Chinese and English databases, including VIP, Wanfang, CNKI, PubMed, EMBASE, and DSR. The search strategy involved selecting relevant literature based on inclusion and exclusion criteria. The Chinese search formula included combinations of terms for "colorectal cancer," "rectal cancer," or "colon cancer," with "surgical site infection," "incision infection," and "risk factors," or "influencing factors" or "related factors." The English search strategy used "colorectal neoplasms" and "surgical wound infection" combined with "risk factors," "influence factors," or "dangerous factors." Searches were tailored by combining phrases freely and, when necessary, seeking related literature—the search period spanned from January 2015 to December 2022. Inclusion and Exclusion Criteria for Literature Inclusion criteria for the literature were: (1) Studies addressing risk factors or influencing factors for postoperative incision infection in patients with colorectal cancer. (2) Clinical studies in the form of case-control or cohort studies. (3) Studies involving at least 30 patients. (4) Studies involving patients aged between 18 and 80. Exclusion criteria for the literature were: (1) Publications without clinical trials, such as reviews and case analyses. (2) Duplicated publications. (3) Clinical trial articles or documents with incomplete data. (4) Unpublished documents. (5) Studies with too small sample sizes in clinical trials. (6) Studies involving patients who were too young or too old. Literature Screening and Data Extraction Preliminary Screening: A primary search was conducted using combinations of keywords on major literature platforms. Eligible publications were collected and organized using Excel for categorization and sorting, removing duplicates. Initial reviews of collected titles and abstracts were performed to eliminate documents with significant differences. A thorough reading of selected literature was conducted according to acceptance and organization standards to exclude documents that did not meet research criteria, documenting the number of publications and reasons for exclusion. Secondary Screening: Conducted independently by two researchers based on the literature's inclusion and exclusion criteria to further select and extract collected documents, documenting the number and reasons for excluded literature. Tertiary Screening: In cases of disagreement on inclusion between the researchers above, another researcher independently reviewed and resolved discrepancies in literature selection. Literature Quality Assessment This study conducted a literature quality assessment based on the Cochrane risk of bias tool to ensure the reliability of the research findings. Potential biases in each study, such as random sequence generation, allocation concealment, blinding, and outcome assessment, were classified into low, high, or unclear risk categories. Studies were categorized as having a high risk of selection bias if there were significant deficiencies in randomization or allocation concealment, as an unclear risk if there was insufficient information to assess the risk of bias, and as low risk if randomization and allocation concealment were appropriately conducted and blinding was adequately implemented. Furthermore, two researchers assessed the quality of case-control or cohort studies using the Newcastle-Ottawa scale (NOS), which includes four items (4 points) for the selection of study participants, one item (2 points) for the comparability of groups, and three items (3 points) for the outcome measurement, with a total score above 9 considered high quality. The quality of cross-sectional studies was evaluated using the assessment criteria recommended by the Agency for Healthcare Research and Quality (AHRQ), comprising eleven standards such as data sources, inclusion criteria, observation period, continuity of subjects, subjective factors of assessors, and quality control. Studies scoring between 0–3 were considered low quality (Grade C), and those scoring between 4–7 were considered medium quality (Grade B). Statistical Analysis Meta-analysis was performed using R software, selecting r values and their 95% confidence intervals (CI) as the effect size indicators. The chi-squared (X 2 ) test was used to process control trial data from all selected literature, and heterogeneity of the collected experimental data was evaluated using the I 2 statistic. If P > 0.01 and I 2 < 50%, it indicates no difference in the data across the selected literature, allowing for a fixed-effect model to combine and analyze control trial data. If P 50%, an investigation into the sources of data heterogeneity is required, followed by relevant subgroup interventions. If the value remains large, data correlation analysis is conducted using a random-effects model, with odds ratios (OR) used for effect statistics and 95% CI for interval estimation, excluding clinical studies cited no fewer than five times in the literature. Additionally, sensitivity analysis was employed to assess the stability of the research outcomes, with funnel plots drawn to evaluate the potential for publication bias. The significance level for all statistical tests was set at P < 0.05. Results Overview of Literature Retrieval Results Based on the Systematic Screening Process In systematic reviews or meta-analyses, the retrieval and screening of literature are fundamental steps to ensure the quality and comprehensiveness of the research. This study employed a multi-database search strategy and stringent inclusion and exclusion criteria to conduct a comprehensive search and screening of relevant literature. Initially, the search yielded 1,578 articles, including 468 from VIP, 301 from Wanfang, 618 from CNKI, 107 from PubMed, 51 from EMBASE, and 33 from DSR databases. After removing 1,263 duplicates, 315 articles remained for preliminary screening. Through careful reading of titles and abstracts, and based on the objectives and predefined conditions of the study, this number was further reduced to 115 articles. After a detailed full-text review, 11 articles met the study's inclusion and exclusion criteria (Figure 1A). Through a rigorous literature search and screening process, this study successfully identified 11 high-quality studies from a large pool of related literature, providing a solid foundation for subsequent analysis and review. Furthermore, the quality of the included literature was evaluated based on the Cochrane risk of bias tool standards (Figure 1B), ensuring a fair and comprehensive quality review of the included studies. Summary of High-Quality Literature Based on NOS Scores In various fields of scientific research, assessing the quality of literature and interpreting data are crucial. This study conducted an in-depth literature analysis within a specific domain, employing the NOS for literature quality assessment. All included studies scored ≥7 on the NOS, indicating they are of high quality, as detailed in Table 1 [8, 33, 37, 49]. Analysis of Significant Risk Factors for Postoperative Incision Infection in Colorectal Cancer In meta-analysis research, testing for heterogeneity among risk factors is critical in evaluating differences across studies. This process aids in identifying the most suitable effect model to ensure the accuracy and reliability of the analysis results. Our study comprehensively examined six potential risk factors, conducting a detailed assessment of their heterogeneity (Table 2). The analysis identified high body mass index (BMI), diabetes, preoperative low albumin levels, preoperative malnutrition, and surgical duration exceeding 3 hours as significant risk factors for postoperative incision infection in colorectal cancer. Conversely, laparoscopic surgery emerged as a factor associated with a reduced risk of infection (Figure 2). Understanding these factors is crucial for the prevention and management of postoperative incision infection in colorectal cancer. Specific meta-analysis findings include: a BMI≥24kg/m 2 significantly increases the risk of postoperative incision infection (Figure 2A), with a combined OR of 0.03 and a 95% CI of [0.01; 0.10], indicating a significant association. However, this result showed high heterogeneity (I 2 = 97%), suggesting substantial differences between included studies. Diabetes was also a significant risk factor (Figure 2B), despite high heterogeneity (I 2 = 94%), with a combined OR of 0.11 and a 95% CI of [0.03; 0.43], indicating an increased risk of infection post-surgery for patients with diabetes. Preoperative low albumin levels were significantly associated with postoperative incision infection (Figure 2C), with a combined OR of 0.12 and a 95% CI of [0.02; 0.76], despite high study heterogeneity (I 2 = 93%). Laparoscopic surgery appeared to be associated with a lower risk of infection (Figure 2D), with a combined OR of 0.00 [95% CI: 0.00; 0.01], even though its heterogeneity was high (I 2 = 91%). Preoperative malnutrition was significantly linked to an increased risk of incision infection (Figure 2E), with a combined OR of 0.04 and a 95% CI of [0.03; 0.06], and heterogeneity testing (I 2 = 0%) indicated no significant differences between studies. Surgical duration exceeding 3 hours was significantly associated with an increased risk of postoperative incision infection in colorectal cancer (Figure 2F), with a combined OR of 0.05 and a 95% CI of [0.01; 0.24], and heterogeneity testing showed very high differences between studies (I 2 = 98%). Through meta-analysis, this study revealed associations between postoperative incision infection in colorectal cancer and multiple significant risk factors. Factors such as BMI≥24kg/m 2 , diabetes, preoperative low albumin levels, preoperative malnutrition, and surgical duration exceeding 3 hours all demonstrated a significant increase in risk despite high heterogeneity. Meanwhile, the protective role of laparoscopic surgery warrants attention, though its heterogeneity calls for further investigation. These findings emphasize the importance of comprehensive patient assessment and management in clinical practice, particularly identifying and intervening in these risk factors preoperatively to reduce the risk of post-surgery infection. Sensitivity Analysis of Risk Factors for Postoperative Incision Infection in Colorectal Cancer Shows High Stability The sensitivity analysis of multiple risk factors for postoperative incision infection in colorectal cancer, conducted through meta-analysis, demonstrated that BMI≥24kg/m 2 , diabetes, low albumin levels, laparoscopic surgery, and preoperative malnutrition significantly impact the risk of incision infection (Figure 3). The analysis confirmed the stability and reliability of these factors' associations, indicating that no single study had a decisive impact on the overall conclusions. Despite high heterogeneity, the sensitivity analysis showed that removing any one study did not materially alter the combined effect size and 95% CIs, thereby not affecting the overall conclusions significantly. Notably, the analysis of laparoscopic surgery methods revealed a shallow risk of incision infection, while the robust analysis of preoperative malnutrition and surgical duration further emphasized their consistency as essential considerations. These findings highlight the importance of recognizing and managing these risk factors in reducing the risk of postoperative incision infection in colorectal cancer. Assessment of Publication Bias Strengthens the Credibility of Research on Risk Factors for Postoperative Infection in Colorectal Cancer In a series of meta-analyses on risk factors for postoperative infection in colorectal cancer, funnel plots were utilized to assess publication bias (Figure 4). The analysis of these funnel plots revealed an excellent symmetry between the effect sizes and their standard errors for most studies, indicating a low risk of publication bias. While some studies deviated from the expected symmetric distribution, potentially reflecting heterogeneity among studies or the impact of specific study conditions, no evident one-sided skew or gaps were observed. This further supports the robustness and credibility of the meta-analysis results. In summary, despite some heterogeneity among studies, the overall evidence suggests that the analysis linking these risk factors to the risk of postoperative infection in colorectal cancer is robust and highly credible. This provides critical guidance for clinicians in preoperative assessment and risk management, contributing to improved prevention and management of postoperative infections. Discussion In recent years, changes in dietary patterns and lifestyle habits have led to colorectal cancer becoming a common malignancy within the gastrointestinal tract, with its incidence rate gradually increasing. Annually, approximately 1.2 million new cases and 600,000 deaths are attributed to this disease [ 50 , 51 , 52 ]. Moreover, the age of onset has been trending younger [ 53 ]. Colorectal cancer ranks fourth in incidence and second in mortality among all types of cancer worldwide, posing a serious threat to patient's health and safety [ 54 , 55 , 56 ]. Currently, the preferred treatment for colorectal cancer patients is radical surgery to remove the lesion [ 57 , 58 , 59 ]. Laparoscopic surgery, which allows for the visualization of surrounding tissues, nerves, blood vessels, and ureters, helps minimize damage to surrounding tissues and has shown significant clinical outcomes [ 60 ]. However, patients with colorectal cancer are susceptible to the adverse effects of their condition, leading to poor physical health and reducing their capacity to undergo surgery [ 5 , 38 , 61 ]. The high bacterial content and complex microbiota within the human colorectal cavity also increase the risk of postoperative incision infection [ 62 , 63 ]. During surgery, the spillage of intestinal contents can lead to the displacement and colonization of intestinal pathogens, resulting in a high rate of postoperative incision infections. Incision infections are common complications in clinical surgery and, in severe cases, can lead to systemic infections and sepsis, severely impacting postoperative recovery [ 64 , 65 , 66 ]. Literature reports the rate of incision infections following colorectal surgery ranging from 2.7–26.0% [ 67 , 68 , 69 ]. Colorectal cancer, being a debilitating disease, leads to a decline in patients' immune function, making them more prone to postoperative incision infections [ 70 ]. This study, through a systematic literature review and meta-analysis, delved into several potential risk factors for postoperative incision infection in colorectal cancer, including a BMI of ≥ 24kg/m 2 , diabetes, preoperative low albumin levels, the method of laparoscopic surgery, preoperative malnutrition, and surgical duration exceeding 3 hours. It identified that a BMI of ≥ 24kg/m 2 , preoperative low albumin levels, preoperative malnutrition, and extended surgical duration are significant risk factors for postoperative incision infection, with diabetes also being a crucial risk factor. In contrast, laparoscopic surgery methods appear to be associated with a lower risk of infection (Fig. 5 ). Our findings reveal a significant correlation between these factors and the risk of postoperative incision infection in colorectal cancer, offering essential insights for clinicians in preoperative assessment and postoperative management. Patients with colorectal cancer having a BMI > 24 kg/m 2 indicate obesity, which is problematic due to the substantial subcutaneous fat affecting surgical field exposure and complicated surgical procedures. This condition can increase the difficulty of surgery, extend the operation time, and raise the risk of postoperative incision infection. Obese patients have high-fat content that can inhibit the proliferation of immune cells, thereby increasing the risk of incision infection. Postoperative patients with higher body weight are more prone to abdominal fat liquefaction, with significant body weight being related to enlarged fat tissue and inadequate blood supply. Moreover, such patients often have chronic diseases like hypertension and diabetes, reducing their immune function and thus increasing the likelihood of postoperative incision infection. The incision length is also closely associated with the occurrence of postoperative infection. Additionally, overweight individuals have a higher chance of developing diabetes, altering their immune cell function and inflammatory responses, making overweight and diabetic patients more susceptible to surgical incision infections. Therefore, perioperative anti-infection measures should be taken for patients with high BMI, and appropriate plans should be formulated before surgery to prevent postoperative infections. Previous studies have indicated that a higher BMI in colorectal cancer patients increases the risk of surgical site infections [ 71 , 72 , 73 ]. Hirao et al. found a significant increase in the incidence of incision infections at a BMI ≥ 25 kg/m 2 (OR = 2.28, 95% CI: 1.05 ~ 7.52), consistent with our study findings. Research by Chen Yan et al. showed that obesity affects surgical field exposure and maneuverability due to subcutaneous fat [ 74 , 75 , 76 ]. The surgical incision may be extended to achieve better visibility during surgery, increasing the exposure area and airways. Postoperatively, the incision is prone to liquefaction and necrosis, slowing healing and increasing surgical incision infection incidence. As societal lifestyles change and populations age, the incidence of diabetes is on the rise, leading to an increase in colorectal cancer patients with diabetes. These patients are more susceptible to postoperative incision infections due to immune system dysregulation and suppressed immune functions [ 40 , 77 , 78 ]. Studies have shown that diabetes disrupts glucose metabolism, reduces glycolytic capacity, and weakens neutrophil migration, phagocytosis, and bactericidal functions [ 79 ]. Protein synthesis decreases while degradation accelerates, reducing immunoglobulins' production, complements, and chemotactic factors, thereby diminishing immune function [ 80 , 81 , 82 ]. The immune response in diabetic patients is relatively lower, and surgical trauma exacerbates glucose metabolism disorder. In a hyperglycemic environment, inflammation cell migration to the surgical site is hindered, further lowering the body's immunity and increasing infection risks, consistent with findings by Wukich et al. [ 83 ]. The rate of incision infection in diabetic patients is significantly higher than in non-diabetic patients. The abnormal glucose metabolism in patients with diabetes impairs the normal function of inflammatory factors, facilitating pathogen colonization and growth in a high-glucose microenvironment, thus diminishing the patient's infection resistance. Diabetic patients have microcirculation disorders, leading to a higher risk of anastomotic leakage post-surgery and potential abdominal infections. Diabetes-induced vascular plaque formation causes the narrowing of blood vessels, reducing tissue oxygenation, which can lead to tissue hypoxia, affecting oxidative-mediated microbial killing mechanisms and tissue oxygenation, and delaying tissue healing. Postoperative malnutrition is more likely in diabetic patients, adversely affecting recovery. Furthermore, wound healing in diabetic patients is slower. In healthy individuals, the metabolic level of glucose in diabetic patients is lower than usual, resulting in lower protein synthesis capacity and poorer cellular tissue repair abilities. Severe patients have impaired inflammatory cell function, affecting leukocyte phagocytosis. Immune function is below average, with fewer fibroblasts, hindering granulation tissue formation at the wound site, delaying wound healing, and even causing local edema. Surgical trauma can lead to postoperative stress-induced hyperglycemia, conducive to bacterial growth; a high glucose environment in the blood promotes bacterial colonization. Numerous studies have confirmed the impact of diabetes and perioperative hyperglycemia on surgical site infection. Hyperglycemia provides conditions for bacterial growth, and exudate in a high-glucose environment facilitates bacterial growth, reducing the body's immunity and leading to postoperative incision infections. Immune response functions are relatively lower in colorectal cancer patients with a history of diabetes. Post-laparoscopic surgery, surgical trauma further disrupts glucose metabolism, promoting inflammatory cell migration to the incision site, weakening immunity, and increasing the risk of postoperative incision infections. Persistent hyperglycemia in diabetic patients fosters bacterial growth, thereby increasing the rate of surgical site infections. Glucose metabolism disorder leads to a decreased pathogen clearance capacity, impaired immune function, and reduced infection resistance. Therefore, for colorectal cancer patients with diabetes, perioperative blood glucose management should be strengthened, aiming to keep blood glucose levels between 5.6-11.2mmol/L, minimizing glucose fluctuations and thereby reducing the incidence of postoperative abdominal infections following colorectal cancer resection surgery. Albumin levels directly reflect the nutritional status of the body [ 84 , 85 , 86 ]. Low albumin levels indicate a higher risk of malnutrition, compromising immune function and increasing incision infection risk [ 87 , 88 , 89 ]. Albumin, a significant component of human plasma proteins, is crucial in maintaining internal homeostasis [ 90 ]. Low albumin levels reduce a patient's immunity, leading to drug absorption and metabolic disorders and complicating wound healing [ 91 , 92 ]. Therefore, clinical nutritional support should be intensified for such patients to boost their resistance, emphasizing the importance of preoperative nutritional interventions to enhance patient resilience [ 93 , 94 ]. Surgical methods include traditional open surgery and laparoscopic surgery [ 95 ]. Studies have shown that traditional open surgery, with its extensive trauma and significant blood loss, complicates postoperative recovery [ 96 , 97 , 98 ]. Laparoscopic surgery, a significant advancement in modern science, has emerged as a new option for curative resection of colorectal cancer [ 67 , 99 , 100 ]. It allows for precise observation of the surrounding tissue of the lesion, thus minimizing damage [ 101 ]. Open surgery requires an extended incision to ensure an excellent surgical field of view [ 102 , 103 ]. The larger incision, exposed to air for an extended period during surgery, significantly increases the risk of infection and may impact wound healing [ 104 ]. Laparoscopic surgery facilitates precise observation of the lesion's surrounding tissues, nerves, blood vessels, and ureters, minimizing damage [ 105 ]. With the advancement of laparoscopic techniques, pain post-colorectal cancer surgery has significantly reduced, and the recovery time has considerably shortened [ 106 , 107 , 108 ]. The incision length in laparoscopic surgery is notably shorter than in open surgery, reducing skin integrity damage, bacterial displacement within the skin, and challenges in incision healing [ 109 , 110 , 111 , 112 ]. Additionally, laparoscopic surgery, with its minimal tissue damage and smaller incisions, facilitates postoperative recovery, encouraging early patient mobilization to support wound healing and lower postoperative incision infection rates [ 110 , 111 , 112 ]. Some studies have found that laparoscopic surgery minimally impacts human immune function and injury, making postoperative incision infections less likely [ 113 , 114 ]. Therefore, the choice of surgical method is particularly crucial, with a preference for laparoscopic surgery when possible [ 115 , 116 ]. Research indicates that in a single-center randomized controlled trial, the postoperative incision infection rate for patients undergoing laparoscopic surgery for colorectal cancer was 4.9% (47/961), significantly lower than the open surgery group (9.6%, 95/986) [ 117 , 118 , 119 , 120 ]. This difference may be due to laparoscopic surgery reducing the direct contact between organs and environmental pathogens. Additionally, laparoscopic surgery avoids factors like peritonitis, increased intestinal permeability, and intestinal edema that are prone to surgical site infections, thereby lowering the rate of postoperative incision infections [ 121 , 122 , 123 ]. Nutritional status is a primary concern in the perioperative management of colorectal cancer patients [ 124 , 125 ]. Malnutrition lowers cellular and humoral immune responses, and correcting malnutrition can reduce the incidence of perioperative complications by up to 10% [ 126 , 127 , 128 ]. The occurrence rate of perioperative complications is as high as 10% [ 129 , 130 , 131 ]. Although no universal definition for diagnosing malnutrition, it typically encompasses conditions related to inadequate food intake, weight loss, and a low BMI [ 132 , 133 , 134 ]. The European Society for Clinical Nutrition and Metabolism (ESPEN) defines malnutrition to include at least one of the following criteria: a weight loss of more than 10% of the original weight within six months, a BMI lower than 18.5 kg/m 2 , serum albumin less than 35 g/L, in the absence of liver or kidney dysfunction [ 135 , 136 , 137 , 138 , 139 , 140 ]. Fujimichi et al. reported that malnutrition is an independent risk factor for postoperative incision infection in colorectal cancer patients (OR = 2.52, 95%, p = 0.01) [ 42 , 141 , 142 ]. Furthermore, a registry study at the Hokeland University Hospital in Norway showed that among 1194 patients undergoing surgical treatment, those at nutritional risk were more likely to develop incision infections, with a positive correlation between the incidence of incision infections and nutritional risk (OR = 1.81, p = 0.047) [ 143 , 144 , 145 , 146 ]. ESPEN recommends that severely malnourished patients scheduled for major gastrointestinal surgery should receive preoperative nutritional support for 10–14 days. Enteral nutrition should be the first choice if there are no contraindications [ 147 , 148 , 149 , 150 ]. Enhancing perioperative nutrition and supportive care is crucial for malnourished patients, ensuring sufficient energy and nutrient intake to prevent perioperative incision infections. Malnourished colorectal cancer patients often have electrolyte imbalances, anemia, and lower immunity, increasing the risk of postoperative incision infections. Patients should receive enteral nutrition as soon as gastrointestinal recovery permits, maintaining the intestinal barrier and immune barrier, reducing endotoxin absorption and intestinal flora displacement, thereby providing a conducive internal environment for wound healing [ 49 , 151 , 152 , 153 , 154 , 155 ]. This study's findings indicate that a surgical duration exceeding three hours is a risk factor for surgical site infections in patients with colorectal cancer, aligning with Katsuno's research. It has been shown that the risk of postoperative incision infection in colorectal cancer increases with the length of the surgery [ 156 , 157 , 158 , 159 ]. Extended surgical times are often associated with increased blood loss, potentially leading to tissue hypoxia [ 160 , 161 , 162 ]. Longer surgeries inevitably carry a higher risk of bleeding and increased blood loss, reducing the body's resistance and inducing infection [ 163 ]. The longer the surgery, the more energy the patient expends, raising the risk of exogenous infection and, thereby, the risk of postoperative incision infection [ 164 , 165 , 166 ]. Prolonged surgical duration also means the sterile environment within the abdomen is exposed to air for a longer time [ 167 , 168 , 169 ]. Even in an operation meeting standard requirements, air cleanliness decreases with extended surgical times, increasing the probability of local bacterial contamination [ 170 , 171 , 172 ]. The wound's exposure to air also increases, leading to a higher bacterial count at the incision site and increasing the possibility of tissue cell destruction. Longer surgeries, extended exposure to tissue traction, and prolonged use of surgical energy devices can damage tissues. Moreover, extended anesthesia can adversely affect the patient's immune function. The body's immunity diminishes as anesthesia duration and intraoperative blood loss increase. The length of the surgery is not only related to the patient's physical condition but also largely depends on the surgeon's skill and proficiency in the operation. Thus, an increased rate of postoperative incision infection indicates that more complex, challenging, and traumatic surgeries with longer durations lead to higher infection rates [ 173 , 174 ]. Therefore, enhancing the surgical skills and intraoperative proficiency of surgeons, reducing surgical trauma, shortening surgical duration, and lowering the incidence of incision infections is paramount. Zheng Hui's multivariate analysis of 2308 patients showed that surgical duration (OR = 1.007, 95% CI: 1.002 ~ 1.012) is an independent risk factor for incision infection [ 175 ]. Thus, effectively controlling surgical duration can significantly reduce the incidence of incision infections [ 176 , 177 , 178 ]. Based on the analysis of various risk factors, future clinical practices can implement the following strategies to prevent postoperative incision infections in patients with colorectal cancer: (1) Preoperative: Implement infection prevention measures and avoid scheduling surgeries during summer. For diabetic patients, intensify monitoring and control of blood glucose levels and use insulin judiciously. Surgery should proceed only when blood glucose levels are within normal ranges. For elderly patients, complications should be vigilantly monitored and actively managed preoperatively. Additionally, patients' nutritional status should be assessed, and timely nutritional support should be provided to those with low serum albumin to ensure balanced daily nutrient intake and optimal preoperative nutrition. (2) Intraoperative: Adhere to standard sterile procedures, minimize electrosurgical use in patients with thick adipose layers, and adjust the electrosurgical power as necessary. Inactive fatty tissue should be rinsed with saline during incision closure. Moreover, surgical preparations should be meticulously planned, requiring close cooperation among medical staff to enhance procedural proficiency and actively manage surgical duration. When appropriate, consider laparoscopic surgery for its reduced patient trauma and lower postoperative incision infection rates, taking into account the patient's specific health status and condition. (3) Postoperative: Monitor changes in patient vitals, replenish energy promptly as needed, and encourage high-fiber and protein-rich foods to boost nutrition and maintain electrolyte balance. Pay attention to changes in the nature, volume, and color of drainage fluid, replace drainage bags timely to prevent incision-related infections, and regularly change wound dressings to prevent bacterial growth and infection. Despite our study's rigorous design and execution, it has limitations. First, the significant heterogeneity among studies may affect the robustness of our conclusions, although sensitivity analysis and publication bias assessment have been conducted to ensure the reliability of the results. Second, the quality of included studies varies, and despite rigorous evaluation using the Cochrane risk of bias tool and NOS scoring system, the impact of low-quality studies must be partially ruled out. Additionally, language and database search limitations might have led to selection bias due to potentially relevant studies needing to be included. Future research should further explore the causal relationships between these risk factors and postoperative incision infections in colorectal cancer and how they interact with other potential risk factors. Moreover, as medical technology advances, new surgical techniques and postoperative management strategies may influence the risk of postoperative incision infections in colorectal cancer. Therefore, ongoing research and updated meta-analyses must ensure our conclusions reflect the latest scientific evidence. In summary, this study provides critical insights into the risk factors for postoperative incision infection in colorectal cancer, emphasizing the importance of comprehensive assessment and management of these risk factors in clinical practice. By early identification and intervention of these risk factors, the incidence of postoperative incision infections in colorectal cancer patients can potentially be reduced, thereby improving patient prognosis and quality of life. Future research should aim to explore additional potential risk factors and evaluate the effectiveness of various prevention and management strategies to optimize postoperative care for colorectal cancer patients further. Declarations Ethical Statement No need. Funding This work was supported by National Natural Science Foundation of China (No. 82373336). Acknowledgment None. Conflict of Interest The author declares no conflict of interest. Data Availability All data can be provided as needed. Author Contributions Jia Li contributed to conceptualization, investigation, methodology, and writing of the original draft. Zhao Huacai was involved in investigation, methodology, supervision, visualization, and writing the original draft. Liu Jia participated in data curation, methodology, and writing the original draft. All authors have reviewed and approved the final manuscript. References Lu L, Mullins CS, Schafmayer C, Zeißig S, Linnebacher M. A global assessment of recent trends in gastrointestinal cancer and lifestyle-associated risk factors. Cancer Commun (Lond). 2021;41(11):1137-1151. doi:10.1002/cac2.12220 Hang D, Shen H. Sex Hormone and Colorectal Cancer: The Knowns and Unknowns. Cancer Epidemiol Biomarkers Prev. 2021;30(7):1302-1304. doi:10.1158/1055-9965.EPI-21-0472 Ohno Y, Mazaki J, Udo R, et al. 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Oncol Lett. 2019;17(2):1603-1608. doi:10.3892/ol.2018.9798 Amri R, Dinaux AM, Kunitake H, Bordeianou LG, Berger DL. Risk Stratification for Surgical Site Infections in Colon Cancer. JAMA Surg. 2017;152(7):686-690. doi:10.1001/jamasurg.2017.0505 Warps AK, Zwanenburg ES, Dekker JWT, et al. Laparoscopic Versus Open Colorectal Surgery in the Emergency Setting: A Systematic Review and Meta-analysis. Ann Surg Open. 2021;2(3):e097. Published 2021 Sep 14. doi:10.1097/AS9.0000000000000097 Sun R, Zhang Y, Feng B, et al. Intracorporeal Anastomosis Versus Extracorporeal Anastomosis in Laparoscopic Right Colectomy: An Observational Cohort Study. World J Surg. 2023;47(3):785-795. doi:10.1007/s00268-022-06834-0 Albo D. Targeting Surgical Site Infection-Reducing Bundles Selectively to At-Risk Colon Cancer Surgery Populations: Achieving Value in a MACRA World?. JAMA Surg. 2017;152(7):690. doi:10.1001/jamasurg.2017.0506 Alias D, Ruiz-Tovar J, Moreno A, et al. 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JAMA Surg. 2023;158(6):572-581. doi:10.1001/jamasurg.2023.0198 CReST Collaborative Group. Colorectal Endoscopic Stenting Trial (CReST) for obstructing left-sided colorectal cancer: randomized clinical trial. Br J Surg. 2022;109(11):1073-1080. doi:10.1093/bjs/znac141 Garay MB, Carbajal-Maldonado ÁL, Rodriguez-Ortiz-DE-Rozas R, Guilabert L, DE-Madaria E. Post-surgical exocrine pancreatic insufficiency. Minerva Surg. 2023;78(6):671-683. doi:10.23736/S2724-5691.23.10125-0 de van der Schueren MAE, Borkent JW, Spaans GW, Nijhof A, Manders M. GLIM in nursing homes; practical implications. Clin Nutr. 2022;41(11):2442-2445. doi:10.1016/j.clnu.2022.09.003 Mikkelsen S, Geisler L, Holst M. Malnutrition measured by unintended weight loss among patients in general practice. Nutrition. 2022;96:111554. doi:10.1016/j.nut.2021.111554 Nakamura T, Sato T, Takayama Y, et al. Risk Factors for Surgical Site Infection after Laparoscopic Surgery for Colon Cancer. Surg Infect (Larchmt). 2016;17(4):454-458. doi:10.1089/sur.2015.205 Suzuki T, Sadahiro S, Tanaka A, et al. Usefulness of Preoperative Mechanical Bowel Preparation in Patients with Colon Cancer who Undergo Elective Surgery: A Prospective Randomized Trial Using Oral Antibiotics. Dig Surg. 2020;37(3):192-198. doi:10.1159/000500020 Nakamura T, Takayama Y, Sato T, Watanabe M. Risk Factors for Wound Infection After Laparoscopic Surgery for Colon Cancer. Surg Laparosc Endosc Percutan Tech. 2020;30(1):45-48. doi:10.1097/SLE.0000000000000735 Puri P, Dhiman RK, Taneja S, et al. Nutrition in Chronic Liver Disease: Consensus Statement of the Indian National Association for Study of the Liver. J Clin Exp Hepatol. 2021;11(1):97-143. doi:10.1016/j.jceh.2020.09.003 Piccoli GB, Cederholm T, Avesani CM, et al. Nutritional status and the risk of malnutrition in older adults with chronic kidney disease - implications for low protein intake and nutritional care: A critical review endorsed by ERN-ERA and ESPEN. Clin Nutr. 2023;42(4):443-457. doi:10.1016/j.clnu.2023.01.018 Muscaritoli M, Imbimbo G, Jager-Wittenaar H, et al. Disease-related malnutrition with inflammation and cachexia. Clin Nutr. 2023;42(8):1475-1479. doi:10.1016/j.clnu.2023.05.013 Tajima Y, Ishida H, Yamamoto A, et al. Comparison of the risk of surgical site infection and feasibility of surgery between sennoside versus polyethylene glycol as a mechanical bowel preparation of elective colon cancer surgery: a randomized controlled trial. Surg Today. 2016;46(6):735-740. doi:10.1007/s00595-015-1239-7 Benedek Z, Coroş MF. The impact of sarcopenia on the postoperative outcome in colorectal cancer surgery. Med Pharm Rep. 2023;96(1):20-27. doi:10.15386/mpr-2483 Ojima H, Sohda M, Ando H, et al. Relationship between functional end-to-end anastomosis for colon cancer and surgical site infections. Surg Today. 2015;45(12):1489-1492. doi:10.1007/s00595-015-1110-x Global Cardiovascular Risk Consortium, Magnussen C, Ojeda FM, et al. Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality. N Engl J Med. 2023;389(14):1273-1285. doi:10.1056/NEJMoa2206916 Bouras E, Karhunen V, Gill D, et al. Circulating inflammatory cytokines and risk of five cancers: a Mendelian randomization analysis. BMC Med. 2022;20(1):3. Published 2022 Jan 11. doi:10.1186/s12916-021-02193-0 Bellenguez C, Küçükali F, Jansen IE, et al. New insights into the genetic etiology of Alzheimer's disease and related dementias. Nat Genet. 2022;54(4):412-436. doi:10.1038/s41588-022-01024-z Kogo H, Yamamoto K, Yoshida H. A case of transverse colon cancer with a large liver abscess that could be treated with a radical operation after infection control. Int J Surg Case Rep. 2020;77:182-186. doi:10.1016/j.ijscr.2020.10.122 Jabłońska B, Mrowiec S. Nutritional Support in Patients with Severe Acute Pancreatitis-Current Standards. Nutrients. 2021;13(5):1498. Published 2021 Apr 28. doi:10.3390/nu13051498 Adeyinka A, Rouster AS, Valentine M. Enteric Feedings. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 26, 2022. Lesser MNR, Lesser LI. Nutrition Support Therapy. Am Fam Physician. 2021;104(6):580-588. Jin L, Zhang X, Deng L, et al. Analysis of risk factors for concurrent pulmonary infection after operation for colon cancer. J BUON. 2019;24(2):436-441. Ortiz H, Armendariz P, Kreisler E, et al. Influence of rescrubbing before laparotomy closure on abdominal wound infection after colorectal cancer surgery: results of a multicenter randomized clinical trial. Arch Surg. 2012;147(7):614-620. doi:10.1001/archsurg.2012.150 Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745-4761. doi:10.1016/j.clnu.2021.03.031 Wobith M, Weimann A. Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery. Nutrients. 2021;13(8):2655. Published 2021 Jul 30. doi:10.3390/nu13082655 Bischoff SC, Escher J, Hébuterne X, et al. Guía ESPEN: Nutrición clínica en la enfermedad inflamatoria intestinal [ESPEN guideline: Clinical nutrition in inflammatory bowel disease]. Nutr Hosp. 2022;39(3):678-703. doi:10.20960/nh.03857 Lee SY, Lee J, Park HM, Kim CH, Kim HR. Impact of Preoperative Immunonutrition on the Outcomes of Colon Cancer Surgery: Results from a Randomized Controlled Trial. Ann Surg. 2023;277(3):381-386. doi:10.1097/SLA.0000000000005140 Wang R, Dai W, Gong J, et al. Development of a novel combined nomogram model integrating deep learning-pathomics, radiomics and immunoscore to predict postoperative outcome of colorectal cancer lung metastasis patients. J Hematol Oncol. 2022;15(1):11. Published 2022 Jan 24. doi:10.1186/s13045-022-01225-3 Feng L, Liu Z, Li C, et al. Development and validation of a radiopathomics model to predict pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a multicentre observational study. Lancet Digit Health. 2022;4(1):e8-e17. doi:10.1016/S2589-7500(21)00215-6 Zhu J, Lian J, Xu B, et al. Neoadjuvant immunotherapy for colorectal cancer: Right regimens, right patients, right directions?. Front Immunol. 2023;14:1120684. Published 2023 Mar 6. doi:10.3389/fimmu.2023.1120684 Yamada K, Imaizumi J, Kato R, Takada T, Ojima H. Streamlining robotic-assisted abdominoperineal resection. World J Surg Oncol. 2023;21(1):392. Published 2023 Dec 20. doi:10.1186/s12957-023-03260-x Machairas N, Dorovinis P, Kykalos S, et al. Simultaneous robotic-assisted resection of colorectal cancer and synchronous liver metastases: a systematic review. J Robot Surg. 2021;15(6):841-848. doi:10.1007/s11701-021-01213-8 Kim TY, Cho JH, Choi YS, Kim HK, Kim JG, Shim YM. Surgical Strategy for Primary Colorectal Carcinoma and Synchronous Pulmonary Metastasis Resection. J Chest Surg. 2022;55(1):37-43. doi:10.5090/jcs.21.118 Zhan Q, Jiang C. Chromoendoscopy Plus Mucosal Resection Versus Conventional Electrocoagulation for Intestinal Polyps in Children: Two Case Series. J Laparoendosc Adv Surg Tech A. 2018;28(11):1403-1407. doi:10.1089/lap.2017.0633 Gao J, Wang Y, Song J, Li Z, Ren J, Wang P. Negative pressure wound therapy for surgical site infections: A systematic review and meta-analysis [published correction appears in J Adv Nurs. 2022 Jun;78(6):1848]. J Adv Nurs. 2021;77(10):3980-3990. doi:10.1111/jan.14876 Slagter JS, Outmani L, Tran KTCK, Ijzermans JNM, Minnee RC. Robot-assisted kidney transplantation as a minimally invasive approach for kidney transplant recipients: A systematic review and meta-analyses. Int J Surg. 2022;99:106264. doi:10.1016/j.ijsu.2022.106264 Theodorou C, Simpson GS, Walsh CJ. Theatre ventilation. Ann R Coll Surg Engl. 2021;103(3):151-154. doi:10.1308/rcsann.2020.7146 Niederman MS, Baron RM, Bouadma L, et al. Initial antimicrobial management of sepsis. Crit Care. 2021;25(1):307. Published 2021 Aug 26. doi:10.1186/s13054-021-03736-w Ojima T, Nakamura M, Hayata K, et al. Short-term Outcomes of Robotic Gastrectomy vs Laparoscopic Gastrectomy for Patients With Gastric Cancer: A Randomized Clinical Trial. JAMA Surg. 2021;156(10):954-963. doi:10.1001/jamasurg.2021.3182 Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P. Comparison of the Efficacy of the Various Treatment Modalities in the Management of Perianal Crohn's Fistula: A Review. Cureus. 2020;12(12):e11882. Published 2020 Dec 3. doi:10.7759/cureus.11882 Solaini L, Cavaliere D, Avanzolini A, Rocco G, Ercolani G. Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis. J Robot Surg. 2022;16(4):775-781. doi:10.1007/s11701-021-01312-6 Cuk P, Kjær MD, Mogensen CB, Nielsen MF, Pedersen AK, Ellebæk MB. Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis. Surg Endosc. 2022;36(1):32-46. doi:10.1007/s00464-021-08782-7 Marescaux J, Seeliger B. Robotic surgery: a time of change. Updates Surg. 2023;75(4):793-794. doi:10.1007/s13304-023-01546-z Sánchez-Velázquez P, Pera M, Jiménez-Toscano M, et al. Postoperative intra-abdominal infection is an independent prognostic factor of disease-free survival and disease-specific survival in patients with stage II colon cancer. Clin Transl Oncol. 2018;20(10):1321-1328. doi:10.1007/s12094-018-1866-8 Allen N, Adam M, O'Regan G, et al. Outpatient parenteral antimicrobial therapy (OPAT) for aortic vascular graft infection; a five-year retrospective evaluation. BMC Infect Dis. 2021;21(1):670. Published 2021 Jul 9. doi:10.1186/s12879-021-06373-4 Gong Y, Wang X, Li N, et al. A Partially Randomized Patient Preference Trial to Assess the Quality of Life and Patency Rate After Minimally Invasive Cardiac Surgery-Coronary Artery Bypass Grafting: Design and Rationale of the MICS-CABG PRPP Trial. Front Cardiovasc Med. 2022;9:804217. Published 2022 Apr 25. doi:10.3389/fcvm.2022.804217 Tserenpuntsag B, Haley V, Van Antwerpen C, et al. Surgical site infection risk factors identified for patients undergoing colon procedures, New York State 2009-2010. Infect Control Hosp Epidemiol. 2014;35(8):1006-1012. doi:10.1086/677156 Rossiter N. Levelling up: prioritisation of global health. Eur J Orthop Surg Traumatol. 2023;33(3):559-563. doi:10.1007/s00590-022-03394-w Dwan K, Kirkham J, Paton RW, Morley E, Newton AW, Perry DC. Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age. Cochrane Database Syst Rev. 2022;10(10):CD012717. Published 2022 Oct 10. doi:10.1002/14651858.CD012717.pub2 Tables Table 1. Characteristics and quality evaluation of included documents. Author Region Research Type Case Group/Exposure Group (Example) Control Group/Unexposed Group (Example) Risk Factor Nos Score Ni et al. (DOI:10.3969/j.issn.1009-7147.2022.05.052) China Case control 24 38 1.2 7 Deng et al. (Deng Zhenwei,Chen Guohao,Tang Yuxin et al. Analysis of prognostic factors of incision infection after colorectal cancer surgery[J]. China Prescription Drugs,2022,20(06):126-128.) China Case control 13 187 1.2.5.8 8 Wang et al. (WANG Yongli. Factors associated with postoperative incision infection in colorectal cancer patients and nursing intervention[J]. Clinical Research,2021,29(12):160-163.) China Case control 60 837 1.2.5.6.7.8 7 Zhao et al. (DOI: 10.13463/j.cnki.cczyy.2021.04.035) China Case control 15 185 2.5.6 8 Atsushi et al. (DOI:10.1007/s12672-021-00396-8) Japan Case control 95 3075 1.3 8 Liu et al. (DOI:10.3969/j.issn.1674-4985.2020.19.040) China Case control 61 660 1.2 7 Ma et al. (DOI: 10.16073/j.cnki.cjcpt.2020.05.09) China Case control 17 265 1.2.7 7 Wu et al. (DOI:CNKI:SUN:ZHYY.0.2018-13-025) China Case control 14 134 1.4.5.8 7 Li et al. (DOI:10.3969/j.issn.1000-1174.2020.11.024) China Case control 12 114 2.4.5.8 8 Liang et al. (DOI: 10.19668/j.cnki.issn1674-0491.2018.03.006) China Case control 30 173 2.8 7 Zhu et al. (DOI:10.11816/cn.ni.2015-135784) China Case control 38 158 1.2.3.5.8 7 Note: 1: BMI ≥ 25 kg/m 2 ; 2: diabetes; 3: placing subcutaneous drainage; 4. Preoperative low albumin; 5 surgical methods; 6: malnutrition; 7: age; 8: The duration of operation is > 3h. Table 2. Overview of heterogeneity tests and effect model selection for various risk factors. Risk factor Number of documents Heterogeneity test Effect model I 2 (%) P BMI≥24kg/m 2 6 97 <0.01 Random effect model Diabetes 11 94 <0.01 Random effect model Preoperative low albumin 4 93 <0.01 Random effect model Operation mode 7 91 3h 4 98 <0.01 Random effect model Note: I 2 , I-squared statistic for heterogeneity; P, P-value for heterogeneity; the I 2 statistic describes the percentage of total variation across studies that is due to heterogeneity rather than chance. A higher I 2 value indicates greater heterogeneity. The P-value tests the null hypothesis that the studies are homogeneous. The effect model column indicates the statistical model applied for the meta-analysis based on the heterogeneity test results: a Random effect model is used when significant heterogeneity is detected, and a Fixed effect model is employed when heterogeneity is low or not statistically significant. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4262701","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308783708,"identity":"aa4cf236-167c-45df-84e7-5c6ff175bda0","order_by":0,"name":"Jia Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIie3RsUoDMRjA8S8EcssHXSsVfYUvFBQReq+ScOB0FKVQHKQEhHa5Bzixb+ELpBzYRZxPHGynWzocCOLg4OUWccjZ0SH/IUPID5IvAKHQP6wXLSzVdHN0HJmf3X4XOcie1FV++TiUmWUtwr8IlYreseYaSrUnAav0A5JQ7K6qNmw+i2Pgq1eE0dgnmFkVckmH42iQSsPmhc5AJOcIycRHODMXtCMxYfcpa4hVCHgyQLDaeIjgcPqJxLV5WW+NuxhC76OToACSLSnBXYyzrNnrJH1EJXNyQ05lrp6btxRieLakxEvit6r5yi/3letNXU9ncbS43Za765GX/E61E3EL7XU+FAqFQp6+AcerVP3juplQAAAAAElFTkSuQmCC","orcid":"","institution":"Dayi Hospital, Chengdu Third People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jia","middleName":"","lastName":"Li","suffix":""},{"id":308783709,"identity":"cfb0b9ae-9718-4f48-82c5-fd7ce8c5206b","order_by":1,"name":"Huacai Zhao","email":"","orcid":"","institution":"Dayi Hospital, Chengdu Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huacai","middleName":"","lastName":"Zhao","suffix":""},{"id":308783710,"identity":"65350ef1-e1aa-4202-8443-ea5561b334e4","order_by":2,"name":"Jia Liu","email":"","orcid":"","institution":"Chengdu Fifth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-04-13 17:44:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4262701/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4262701/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58144434,"identity":"4e16d4d3-f015-451c-991a-6dafa91142db","added_by":"auto","created_at":"2024-06-11 18:24:56","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2631350,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLiterature screening process and quality assessment results of included studies.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: (A) Flowchart of literature inclusion. (B) Summary of bias risk assessment for included studies.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4262701/v1/89516d454e110a112cdf6f5d.jpg"},{"id":58144439,"identity":"d9c0df41-4dad-4c81-b34d-005f7333649b","added_by":"auto","created_at":"2024-06-11 18:24:56","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":6877252,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKey risk factors for postoperative incision infection in colorectal cancer.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: (A) Association between BMI≥24kg/m\u003csup\u003e2\u003c/sup\u003e and postoperative incision infection in colorectal cancer. (B) Forest plot analyzing the risk of postoperative incision infection in colorectal cancer associated with diabetes. (C) Forest plot analyzing the impact of preoperative low albumin levels on the risk of postoperative incision infection in colorectal cancer. (D) Association between surgical methods and the risk of postoperative incision infection in colorectal cancer. (E) Association between preoperative malnutrition and the risk of postoperative incision infection in colorectal cancer. (F) Association between surgical duration exceeding 3 hours and the risk of postoperative incision infection in colorectal cancer.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4262701/v1/2533a47b94faf208cf19c4ae.jpg"},{"id":58145478,"identity":"83466e10-24d9-4762-9ff0-e75f1bd506ed","added_by":"auto","created_at":"2024-06-11 18:32:56","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":8070993,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSensitivity analysis of risk factors for postoperative incision infection in colorectal cancer.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: (A) Sensitivity analysis results for the association between BMI≥24kg/m\u003csup\u003e2 \u003c/sup\u003eand the risk of postoperative incision infection in colorectal cancer. (B) Sensitivity analysis results for the association between diabetes and the risk of postoperative incision infection in colorectal cancer. (C) Sensitivity analysis results for the association between preoperative low albumin levels and the risk of postoperative incision infection in colorectal cancer. (D) Sensitivity analysis results for the association between surgical methods and the risk of postoperative incision infection in colorectal cancer. (E) Sensitivity analysis results for the association between preoperative nutritional status and the risk of postoperative incision infection in colorectal cancer. (F) Sensitivity analysis results for the association between surgical duration exceeding 3 hours and the risk of postoperative incision infection in colorectal cancer.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4262701/v1/103e92ae5b7d85f3521495b2.jpg"},{"id":58144435,"identity":"f27a26a5-bc16-407d-862b-49aa116a63c1","added_by":"auto","created_at":"2024-06-11 18:24:56","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2955000,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssessment of publication bias in meta-analysis of risk factors for postoperative infection in colorectal cancer.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: (A) Funnel plot for BMI≥24kg/m\u003csup\u003e2\u003c/sup\u003e as a risk factor. (B) Funnel plot for diabetes as a risk factor. (C) Funnel plot for preoperative low albumin levels as a risk factor. (D) Funnel plot for surgical methods as a risk factor. (E) Funnel plot for preoperative nutritional status as a risk factor. (F) Funnel plot for surgical duration exceeding 3 hours as a risk factor. Each point in the funnel plot represents an estimate of the effect size and its precision for a study.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4262701/v1/eda041491e403021f2e46487.jpg"},{"id":58144437,"identity":"db28403c-dae3-4265-8447-56b9f9c7690c","added_by":"auto","created_at":"2024-06-11 18:24:56","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":3278172,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIllustration of risk factors for postoperative incision infection in colorectal cancer.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4262701/v1/96db9795843e423096f8ad31.jpg"},{"id":58552143,"identity":"1ecdb2cb-6b9c-4a4c-9e40-f828a75f5781","added_by":"auto","created_at":"2024-06-18 07:04:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4666397,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4262701/v1/047ceaab-c86f-4349-9341-7a11b3a714a8.pdf"},{"id":58144433,"identity":"a61f0441-fe97-4844-ab37-309e5cb39931","added_by":"auto","created_at":"2024-06-11 18:24:56","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15607,"visible":true,"origin":"","legend":"","description":"","filename":"Highlight.docx","url":"https://assets-eu.researchsquare.com/files/rs-4262701/v1/ed23582db47c670cb0b6d0db.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"New Insights into Risk Factors for Postoperative Infections in Colorectal Cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColorectal cancer ranks among the malignancies with the highest incidence and mortality rates globally, particularly in developed countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As a significant type of gastrointestinal malignancy, colorectal cancer spreads through lymphatic and blood circulation, imposing significant physical and psychological burdens on patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. According to recent cancer statistics, colorectal cancer ranks third in incidence and fifth in mortality among all cancers in China, with an annual report of 376,000 new cases and 191,000 deaths [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These figures highlight the substantial impact of colorectal cancer on individuals and society and underscore the importance of timely and effective diagnosis and treatment [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinically, surgical resection remains the mainstream treatment for colorectal cancer, with curative surgery being the standard treatment strategy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Although such surgery can control disease progression to some extent, numerous studies have identified postoperative incision infection as a standard and severe complication, which, in severe cases, may lead to sepsis, systemic infection, and death [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Advances in medical technology have made laparoscopic surgery the preferred technique for treating colorectal cancer due to its minimally invasive nature, fewer complications, and faster postoperative recovery [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, the risk of postoperative incision infection persists, affecting patient recovery speed, increasing treatment costs, and exacerbating the burden on healthcare resources [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients undergoing surgery for colorectal cancer face a heightened risk of postoperative incision infection due to the necessity for prolonged fasting and bowel preparation preoperatively and the potential for contamination of the surgical area by intestinal contents during surgery [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, the invasion of pathogens directly causes these infections [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In China, the incidence of surgical site infections reaches as high as 1.01% [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], with rates in specific regions and populations potentially soaring to 20%, especially in resource-constrained developing countries [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough extensive research has been conducted on the risk factors for postoperative incision infection in colorectal cancer, findings remain varied without a unified conclusion [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Factors such as age, medical history, and surgical duration are considered potential influencers of infection risk, yet their relative importance and interactions still need to be fully clarified [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Despite attempts to explore preventative measures, the effectiveness of prevention and treatment strategies requires further research due to issues like insufficient sample sizes and study design biases [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aims to provide a more precise risk assessment and effective prevention strategies for clinical application, thereby improving patient recovery quality and reducing associated medical costs through systematic analysis and meta-analysis of various risk factors for postoperative incision infection in colorectal cancer. Beyond focusing on the direct risk factors, this research also examines how optimizing preoperative preparation, improving surgical techniques, and enhancing postoperative management can effectively reduce the incidence of incision infection. The findings guide clinicians in devising individualized treatment plans, enhancing surgical safety, and improving patient quality of life. Additionally, reducing postoperative incision infections can significantly lower medical costs, alleviate the economic burden on patients and their families, and improve healthcare service quality and patient satisfaction. In summary, this study aims to create a safer and more effective surgical treatment environment for colorectal cancer patients through in-depth analysis and comprehensive evaluation.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eLiterature Source and Retrieval\u003c/h2\u003e \u003cp\u003eThis study searched for risk factors associated with postoperative incision infection in colorectal cancer patients across Chinese and English databases, including VIP, Wanfang, CNKI, PubMed, EMBASE, and DSR. The search strategy involved selecting relevant literature based on inclusion and exclusion criteria. The Chinese search formula included combinations of terms for \"colorectal cancer,\" \"rectal cancer,\" or \"colon cancer,\" with \"surgical site infection,\" \"incision infection,\" and \"risk factors,\" or \"influencing factors\" or \"related factors.\" The English search strategy used \"colorectal neoplasms\" and \"surgical wound infection\" combined with \"risk factors,\" \"influence factors,\" or \"dangerous factors.\" Searches were tailored by combining phrases freely and, when necessary, seeking related literature\u0026mdash;the search period spanned from January 2015 to December 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and Exclusion Criteria for Literature\u003c/h2\u003e \u003cp\u003eInclusion criteria for the literature were: (1) Studies addressing risk factors or influencing factors for postoperative incision infection in patients with colorectal cancer. (2) Clinical studies in the form of case-control or cohort studies. (3) Studies involving at least 30 patients. (4) Studies involving patients aged between 18 and 80.\u003c/p\u003e \u003cp\u003eExclusion criteria for the literature were: (1) Publications without clinical trials, such as reviews and case analyses. (2) Duplicated publications. (3) Clinical trial articles or documents with incomplete data. (4) Unpublished documents. (5) Studies with too small sample sizes in clinical trials. (6) Studies involving patients who were too young or too old.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eLiterature Screening and Data Extraction\u003c/h2\u003e \u003cp\u003ePreliminary Screening: A primary search was conducted using combinations of keywords on major literature platforms. Eligible publications were collected and organized using Excel for categorization and sorting, removing duplicates. Initial reviews of collected titles and abstracts were performed to eliminate documents with significant differences. A thorough reading of selected literature was conducted according to acceptance and organization standards to exclude documents that did not meet research criteria, documenting the number of publications and reasons for exclusion.\u003c/p\u003e \u003cp\u003eSecondary Screening: Conducted independently by two researchers based on the literature's inclusion and exclusion criteria to further select and extract collected documents, documenting the number and reasons for excluded literature.\u003c/p\u003e \u003cp\u003eTertiary Screening: In cases of disagreement on inclusion between the researchers above, another researcher independently reviewed and resolved discrepancies in literature selection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eLiterature Quality Assessment\u003c/h2\u003e \u003cp\u003eThis study conducted a literature quality assessment based on the Cochrane risk of bias tool to ensure the reliability of the research findings. Potential biases in each study, such as random sequence generation, allocation concealment, blinding, and outcome assessment, were classified into low, high, or unclear risk categories. Studies were categorized as having a high risk of selection bias if there were significant deficiencies in randomization or allocation concealment, as an unclear risk if there was insufficient information to assess the risk of bias, and as low risk if randomization and allocation concealment were appropriately conducted and blinding was adequately implemented.\u003c/p\u003e \u003cp\u003eFurthermore, two researchers assessed the quality of case-control or cohort studies using the Newcastle-Ottawa scale (NOS), which includes four items (4 points) for the selection of study participants, one item (2 points) for the comparability of groups, and three items (3 points) for the outcome measurement, with a total score above 9 considered high quality. The quality of cross-sectional studies was evaluated using the assessment criteria recommended by the Agency for Healthcare Research and Quality (AHRQ), comprising eleven standards such as data sources, inclusion criteria, observation period, continuity of subjects, subjective factors of assessors, and quality control. Studies scoring between 0\u0026ndash;3 were considered low quality (Grade C), and those scoring between 4\u0026ndash;7 were considered medium quality (Grade B).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eMeta-analysis was performed using R software, selecting r values and their 95% confidence intervals (CI) as the effect size indicators. The chi-squared (X\u003csup\u003e2\u003c/sup\u003e) test was used to process control trial data from all selected literature, and heterogeneity of the collected experimental data was evaluated using the I\u003csup\u003e2\u003c/sup\u003e statistic. If P\u0026thinsp;\u0026gt;\u0026thinsp;0.01 and I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;\u0026lt;\u0026thinsp;50%, it indicates no difference in the data across the selected literature, allowing for a fixed-effect model to combine and analyze control trial data. If P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 and I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;\u0026gt;\u0026thinsp;50%, an investigation into the sources of data heterogeneity is required, followed by relevant subgroup interventions. If the value remains large, data correlation analysis is conducted using a random-effects model, with odds ratios (OR) used for effect statistics and 95% CI for interval estimation, excluding clinical studies cited no fewer than five times in the literature.\u003c/p\u003e \u003cp\u003eAdditionally, sensitivity analysis was employed to assess the stability of the research outcomes, with funnel plots drawn to evaluate the potential for publication bias. The significance level for all statistical tests was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eOverview of Literature Retrieval Results Based on the Systematic Screening Process\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn systematic reviews or meta-analyses, the retrieval and screening of literature are fundamental steps to ensure the quality and comprehensiveness of the research. This study employed a multi-database search strategy and stringent inclusion and exclusion criteria to conduct a comprehensive search and screening of relevant literature.\u003c/p\u003e\n\u003cp\u003eInitially, the search yielded 1,578 articles, including 468 from VIP, 301 from Wanfang, 618 from CNKI, 107 from PubMed, 51 from EMBASE, and 33 from DSR databases. After removing 1,263 duplicates, 315 articles remained for preliminary screening. Through careful reading of titles and abstracts, and based on the objectives and predefined conditions of the study, this number was further reduced to 115 articles. After a detailed full-text review, 11 articles met the study's inclusion and exclusion criteria (Figure 1A).\u003c/p\u003e\n\u003cp\u003eThrough a rigorous literature search and screening process, this study successfully identified 11 high-quality studies from a large pool of related literature, providing a solid foundation for subsequent analysis and review. Furthermore, the quality of the included literature was evaluated based on the Cochrane risk of bias tool standards (Figure 1B), ensuring a fair and comprehensive quality review of the included studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary of High-Quality Literature Based on NOS Scores\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn various fields of scientific research, assessing the quality of literature and interpreting data are crucial. This study conducted an in-depth literature analysis within a specific domain, employing the NOS for literature quality assessment. All included studies scored ≥7 on the NOS, indicating they are of high quality, as detailed in Table 1 [8, 33, 37, 49].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Significant Risk Factors for Postoperative Incision Infection in Colorectal Cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn meta-analysis research, testing for heterogeneity among risk factors is critical in evaluating differences across studies. This process aids in identifying the most suitable effect model to ensure the accuracy and reliability of the analysis results. Our study comprehensively examined six potential risk factors, conducting a detailed assessment of their heterogeneity (Table 2).\u003c/p\u003e\n\u003cp\u003eThe analysis identified high body mass index (BMI), diabetes, preoperative low albumin levels, preoperative malnutrition, and surgical duration exceeding 3 hours as significant risk factors for postoperative incision infection in colorectal cancer. Conversely, laparoscopic surgery emerged as a factor associated with a reduced risk of infection (Figure 2). Understanding these factors is crucial for the prevention and management of postoperative incision infection in colorectal cancer.\u003c/p\u003e\n\u003cp\u003eSpecific meta-analysis findings include: a BMI≥24kg/m\u003csup\u003e2\u0026nbsp;\u003c/sup\u003esignificantly increases the risk of postoperative incision infection (Figure 2A), with a combined OR of 0.03 and a 95% CI of [0.01; 0.10], indicating a significant association. However, this result showed high heterogeneity (I\u003csup\u003e2\u003c/sup\u003e = 97%), suggesting substantial differences between included studies. Diabetes was also a significant risk factor\u0026nbsp;(Figure 2B), despite high heterogeneity (I\u003csup\u003e2\u003c/sup\u003e = 94%), with a combined OR of 0.11 and a 95% CI of [0.03; 0.43], indicating an increased risk of infection post-surgery for patients with diabetes. Preoperative low albumin levels were significantly associated with postoperative incision infection (Figure 2C), with a combined OR of 0.12 and a 95% CI of [0.02; 0.76], despite high study heterogeneity (I\u003csup\u003e2\u003c/sup\u003e = 93%). Laparoscopic surgery appeared to be associated with a lower risk of infection (Figure 2D), with a combined OR of 0.00 [95% CI: 0.00; 0.01], even though its heterogeneity was high (I\u003csup\u003e2\u003c/sup\u003e = 91%). Preoperative malnutrition was significantly linked to an increased risk of incision infection (Figure 2E), with a combined OR of 0.04 and a 95% CI of [0.03; 0.06], and heterogeneity testing (I\u003csup\u003e2\u003c/sup\u003e = 0%) indicated no significant differences between studies. Surgical duration exceeding 3 hours was significantly associated with an increased risk of postoperative incision infection in colorectal cancer (Figure 2F), with a combined OR of 0.05 and a 95% CI of [0.01; 0.24], and heterogeneity testing showed very high differences between studies (I\u003csup\u003e2\u003c/sup\u003e = 98%).\u003c/p\u003e\n\u003cp\u003eThrough meta-analysis, this study revealed associations between postoperative incision infection in colorectal cancer and multiple significant risk factors. Factors such as BMI≥24kg/m\u003csup\u003e2\u003c/sup\u003e, diabetes, preoperative low albumin levels, preoperative malnutrition, and surgical duration exceeding 3 hours all demonstrated a significant increase in risk despite high heterogeneity. Meanwhile, the protective role of laparoscopic surgery warrants attention, though its heterogeneity calls for further investigation. These findings emphasize the importance of comprehensive patient assessment and management in clinical practice, particularly identifying and intervening in these risk factors preoperatively to reduce the risk of post-surgery infection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSensitivity Analysis of Risk Factors for Postoperative Incision Infection in Colorectal Cancer Shows High Stability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sensitivity analysis of multiple risk factors for postoperative incision infection in colorectal cancer, conducted through meta-analysis, demonstrated that BMI≥24kg/m\u003csup\u003e2\u003c/sup\u003e, diabetes, low albumin levels, laparoscopic surgery, and preoperative malnutrition significantly impact the risk of incision infection (Figure 3). The analysis confirmed the stability and reliability of these factors' associations, indicating that no single study had a decisive impact on the overall conclusions. Despite high heterogeneity, the sensitivity analysis showed that removing any one study did not materially alter the combined effect size and 95% CIs, thereby not affecting the overall conclusions significantly. Notably, the analysis of laparoscopic surgery methods revealed a shallow risk of incision infection, while the robust analysis of preoperative malnutrition and surgical duration further emphasized their consistency as essential considerations. These findings highlight the importance of recognizing and managing these risk factors in reducing the risk of postoperative incision infection in colorectal cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of Publication Bias Strengthens the Credibility of Research on Risk Factors for Postoperative Infection in Colorectal Cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn a series of meta-analyses on risk factors for postoperative infection in colorectal cancer, funnel plots were utilized to assess publication bias (Figure 4). The analysis of these funnel plots revealed an excellent symmetry between the effect sizes and their standard errors for most studies, indicating a low risk of publication bias. While some studies deviated from the expected symmetric distribution, potentially reflecting heterogeneity among studies or the impact of specific study conditions, no evident one-sided skew or gaps were observed. This further supports the robustness and credibility of the meta-analysis results.\u003c/p\u003e\n\u003cp\u003eIn summary, despite some heterogeneity among studies, the overall evidence suggests that the analysis linking these risk factors to the risk of postoperative infection in colorectal cancer is robust and highly credible. This provides critical guidance for clinicians in preoperative assessment and risk management, contributing to improved prevention and management of postoperative infections.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn recent years, changes in dietary patterns and lifestyle habits have led to colorectal cancer becoming a common malignancy within the gastrointestinal tract, with its incidence rate gradually increasing. Annually, approximately 1.2\u0026nbsp;million new cases and 600,000 deaths are attributed to this disease [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Moreover, the age of onset has been trending younger [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Colorectal cancer ranks fourth in incidence and second in mortality among all types of cancer worldwide, posing a serious threat to patient's health and safety [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Currently, the preferred treatment for colorectal cancer patients is radical surgery to remove the lesion [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Laparoscopic surgery, which allows for the visualization of surrounding tissues, nerves, blood vessels, and ureters, helps minimize damage to surrounding tissues and has shown significant clinical outcomes [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. However, patients with colorectal cancer are susceptible to the adverse effects of their condition, leading to poor physical health and reducing their capacity to undergo surgery [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. The high bacterial content and complex microbiota within the human colorectal cavity also increase the risk of postoperative incision infection [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. During surgery, the spillage of intestinal contents can lead to the displacement and colonization of intestinal pathogens, resulting in a high rate of postoperative incision infections. Incision infections are common complications in clinical surgery and, in severe cases, can lead to systemic infections and sepsis, severely impacting postoperative recovery [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Literature reports the rate of incision infections following colorectal surgery ranging from 2.7\u0026ndash;26.0% [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Colorectal cancer, being a debilitating disease, leads to a decline in patients' immune function, making them more prone to postoperative incision infections [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study, through a systematic literature review and meta-analysis, delved into several potential risk factors for postoperative incision infection in colorectal cancer, including a BMI of \u0026ge;\u0026thinsp;24kg/m\u003csup\u003e2\u003c/sup\u003e, diabetes, preoperative low albumin levels, the method of laparoscopic surgery, preoperative malnutrition, and surgical duration exceeding 3 hours. It identified that a BMI of \u0026ge;\u0026thinsp;24kg/m\u003csup\u003e2\u003c/sup\u003e, preoperative low albumin levels, preoperative malnutrition, and extended surgical duration are significant risk factors for postoperative incision infection, with diabetes also being a crucial risk factor. In contrast, laparoscopic surgery methods appear to be associated with a lower risk of infection (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Our findings reveal a significant correlation between these factors and the risk of postoperative incision infection in colorectal cancer, offering essential insights for clinicians in preoperative assessment and postoperative management.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatients with colorectal cancer having a BMI\u0026thinsp;\u0026gt;\u0026thinsp;24 kg/m\u003csup\u003e2\u003c/sup\u003e indicate obesity, which is problematic due to the substantial subcutaneous fat affecting surgical field exposure and complicated surgical procedures. This condition can increase the difficulty of surgery, extend the operation time, and raise the risk of postoperative incision infection. Obese patients have high-fat content that can inhibit the proliferation of immune cells, thereby increasing the risk of incision infection. Postoperative patients with higher body weight are more prone to abdominal fat liquefaction, with significant body weight being related to enlarged fat tissue and inadequate blood supply. Moreover, such patients often have chronic diseases like hypertension and diabetes, reducing their immune function and thus increasing the likelihood of postoperative incision infection. The incision length is also closely associated with the occurrence of postoperative infection. Additionally, overweight individuals have a higher chance of developing diabetes, altering their immune cell function and inflammatory responses, making overweight and diabetic patients more susceptible to surgical incision infections. Therefore, perioperative anti-infection measures should be taken for patients with high BMI, and appropriate plans should be formulated before surgery to prevent postoperative infections. Previous studies have indicated that a higher BMI in colorectal cancer patients increases the risk of surgical site infections [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. Hirao et al. found a significant increase in the incidence of incision infections at a BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e (OR\u0026thinsp;=\u0026thinsp;2.28, 95% CI: 1.05\u0026thinsp;~\u0026thinsp;7.52), consistent with our study findings. Research by Chen Yan et al. showed that obesity affects surgical field exposure and maneuverability due to subcutaneous fat [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. The surgical incision may be extended to achieve better visibility during surgery, increasing the exposure area and airways. Postoperatively, the incision is prone to liquefaction and necrosis, slowing healing and increasing surgical incision infection incidence.\u003c/p\u003e \u003cp\u003eAs societal lifestyles change and populations age, the incidence of diabetes is on the rise, leading to an increase in colorectal cancer patients with diabetes. These patients are more susceptible to postoperative incision infections due to immune system dysregulation and suppressed immune functions [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]. Studies have shown that diabetes disrupts glucose metabolism, reduces glycolytic capacity, and weakens neutrophil migration, phagocytosis, and bactericidal functions [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e]. Protein synthesis decreases while degradation accelerates, reducing immunoglobulins' production, complements, and chemotactic factors, thereby diminishing immune function [\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e]. The immune response in diabetic patients is relatively lower, and surgical trauma exacerbates glucose metabolism disorder. In a hyperglycemic environment, inflammation cell migration to the surgical site is hindered, further lowering the body's immunity and increasing infection risks, consistent with findings by Wukich et al. [\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e]. The rate of incision infection in diabetic patients is significantly higher than in non-diabetic patients. The abnormal glucose metabolism in patients with diabetes impairs the normal function of inflammatory factors, facilitating pathogen colonization and growth in a high-glucose microenvironment, thus diminishing the patient's infection resistance.\u003c/p\u003e \u003cp\u003eDiabetic patients have microcirculation disorders, leading to a higher risk of anastomotic leakage post-surgery and potential abdominal infections. Diabetes-induced vascular plaque formation causes the narrowing of blood vessels, reducing tissue oxygenation, which can lead to tissue hypoxia, affecting oxidative-mediated microbial killing mechanisms and tissue oxygenation, and delaying tissue healing. Postoperative malnutrition is more likely in diabetic patients, adversely affecting recovery. Furthermore, wound healing in diabetic patients is slower. In healthy individuals, the metabolic level of glucose in diabetic patients is lower than usual, resulting in lower protein synthesis capacity and poorer cellular tissue repair abilities. Severe patients have impaired inflammatory cell function, affecting leukocyte phagocytosis. Immune function is below average, with fewer fibroblasts, hindering granulation tissue formation at the wound site, delaying wound healing, and even causing local edema. Surgical trauma can lead to postoperative stress-induced hyperglycemia, conducive to bacterial growth; a high glucose environment in the blood promotes bacterial colonization. Numerous studies have confirmed the impact of diabetes and perioperative hyperglycemia on surgical site infection. Hyperglycemia provides conditions for bacterial growth, and exudate in a high-glucose environment facilitates bacterial growth, reducing the body's immunity and leading to postoperative incision infections. Immune response functions are relatively lower in colorectal cancer patients with a history of diabetes. Post-laparoscopic surgery, surgical trauma further disrupts glucose metabolism, promoting inflammatory cell migration to the incision site, weakening immunity, and increasing the risk of postoperative incision infections. Persistent hyperglycemia in diabetic patients fosters bacterial growth, thereby increasing the rate of surgical site infections. Glucose metabolism disorder leads to a decreased pathogen clearance capacity, impaired immune function, and reduced infection resistance. Therefore, for colorectal cancer patients with diabetes, perioperative blood glucose management should be strengthened, aiming to keep blood glucose levels between 5.6-11.2mmol/L, minimizing glucose fluctuations and thereby reducing the incidence of postoperative abdominal infections following colorectal cancer resection surgery.\u003c/p\u003e \u003cp\u003eAlbumin levels directly reflect the nutritional status of the body [\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e]. Low albumin levels indicate a higher risk of malnutrition, compromising immune function and increasing incision infection risk [\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e]. Albumin, a significant component of human plasma proteins, is crucial in maintaining internal homeostasis [\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e]. Low albumin levels reduce a patient's immunity, leading to drug absorption and metabolic disorders and complicating wound healing [\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e]. Therefore, clinical nutritional support should be intensified for such patients to boost their resistance, emphasizing the importance of preoperative nutritional interventions to enhance patient resilience [\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgical methods include traditional open surgery and laparoscopic surgery [\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e]. Studies have shown that traditional open surgery, with its extensive trauma and significant blood loss, complicates postoperative recovery [\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e, \u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e]. Laparoscopic surgery, a significant advancement in modern science, has emerged as a new option for curative resection of colorectal cancer [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e]. It allows for precise observation of the surrounding tissue of the lesion, thus minimizing damage [\u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOpen surgery requires an extended incision to ensure an excellent surgical field of view [\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e]. The larger incision, exposed to air for an extended period during surgery, significantly increases the risk of infection and may impact wound healing [\u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e]. Laparoscopic surgery facilitates precise observation of the lesion's surrounding tissues, nerves, blood vessels, and ureters, minimizing damage [\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e]. With the advancement of laparoscopic techniques, pain post-colorectal cancer surgery has significantly reduced, and the recovery time has considerably shortened [\u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e, \u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e]. The incision length in laparoscopic surgery is notably shorter than in open surgery, reducing skin integrity damage, bacterial displacement within the skin, and challenges in incision healing [\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e, \u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e]. Additionally, laparoscopic surgery, with its minimal tissue damage and smaller incisions, facilitates postoperative recovery, encouraging early patient mobilization to support wound healing and lower postoperative incision infection rates [\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e]. Some studies have found that laparoscopic surgery minimally impacts human immune function and injury, making postoperative incision infections less likely [\u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e, \u003cspan citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e]. Therefore, the choice of surgical method is particularly crucial, with a preference for laparoscopic surgery when possible [\u003cspan citationid=\"CR115\" class=\"CitationRef\"\u003e115\u003c/span\u003e, \u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e]. Research indicates that in a single-center randomized controlled trial, the postoperative incision infection rate for patients undergoing laparoscopic surgery for colorectal cancer was 4.9% (47/961), significantly lower than the open surgery group (9.6%, 95/986) [\u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e, \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e, \u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e]. This difference may be due to laparoscopic surgery reducing the direct contact between organs and environmental pathogens. Additionally, laparoscopic surgery avoids factors like peritonitis, increased intestinal permeability, and intestinal edema that are prone to surgical site infections, thereby lowering the rate of postoperative incision infections [\u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e, \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e, \u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNutritional status is a primary concern in the perioperative management of colorectal cancer patients [\u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e, \u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e]. Malnutrition lowers cellular and humoral immune responses, and correcting malnutrition can reduce the incidence of perioperative complications by up to 10% [\u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e, \u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e, \u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e]. The occurrence rate of perioperative complications is as high as 10% [\u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e, \u003cspan citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e]. Although no universal definition for diagnosing malnutrition, it typically encompasses conditions related to inadequate food intake, weight loss, and a low BMI [\u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e, \u003cspan citationid=\"CR133\" class=\"CitationRef\"\u003e133\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e]. The European Society for Clinical Nutrition and Metabolism (ESPEN) defines malnutrition to include at least one of the following criteria: a weight loss of more than 10% of the original weight within six months, a BMI lower than 18.5 kg/m\u003csup\u003e2\u003c/sup\u003e, serum albumin less than 35 g/L, in the absence of liver or kidney dysfunction [\u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e135\u003c/span\u003e, \u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e, \u003cspan citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e, \u003cspan citationid=\"CR138\" class=\"CitationRef\"\u003e138\u003c/span\u003e, \u003cspan citationid=\"CR139\" class=\"CitationRef\"\u003e139\u003c/span\u003e, \u003cspan citationid=\"CR140\" class=\"CitationRef\"\u003e140\u003c/span\u003e]. Fujimichi et al. reported that malnutrition is an independent risk factor for postoperative incision infection in colorectal cancer patients (OR\u0026thinsp;=\u0026thinsp;2.52, 95%, p\u0026thinsp;=\u0026thinsp;0.01) [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR141\" class=\"CitationRef\"\u003e141\u003c/span\u003e, \u003cspan citationid=\"CR142\" class=\"CitationRef\"\u003e142\u003c/span\u003e]. Furthermore, a registry study at the Hokeland University Hospital in Norway showed that among 1194 patients undergoing surgical treatment, those at nutritional risk were more likely to develop incision infections, with a positive correlation between the incidence of incision infections and nutritional risk (OR\u0026thinsp;=\u0026thinsp;1.81, p\u0026thinsp;=\u0026thinsp;0.047) [\u003cspan citationid=\"CR143\" class=\"CitationRef\"\u003e143\u003c/span\u003e, \u003cspan citationid=\"CR144\" class=\"CitationRef\"\u003e144\u003c/span\u003e, \u003cspan citationid=\"CR145\" class=\"CitationRef\"\u003e145\u003c/span\u003e, \u003cspan citationid=\"CR146\" class=\"CitationRef\"\u003e146\u003c/span\u003e]. ESPEN recommends that severely malnourished patients scheduled for major gastrointestinal surgery should receive preoperative nutritional support for 10\u0026ndash;14 days. Enteral nutrition should be the first choice if there are no contraindications [\u003cspan citationid=\"CR147\" class=\"CitationRef\"\u003e147\u003c/span\u003e, \u003cspan citationid=\"CR148\" class=\"CitationRef\"\u003e148\u003c/span\u003e, \u003cspan citationid=\"CR149\" class=\"CitationRef\"\u003e149\u003c/span\u003e, \u003cspan citationid=\"CR150\" class=\"CitationRef\"\u003e150\u003c/span\u003e]. Enhancing perioperative nutrition and supportive care is crucial for malnourished patients, ensuring sufficient energy and nutrient intake to prevent perioperative incision infections. Malnourished colorectal cancer patients often have electrolyte imbalances, anemia, and lower immunity, increasing the risk of postoperative incision infections. Patients should receive enteral nutrition as soon as gastrointestinal recovery permits, maintaining the intestinal barrier and immune barrier, reducing endotoxin absorption and intestinal flora displacement, thereby providing a conducive internal environment for wound healing [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR151\" class=\"CitationRef\"\u003e151\u003c/span\u003e, \u003cspan citationid=\"CR152\" class=\"CitationRef\"\u003e152\u003c/span\u003e, \u003cspan citationid=\"CR153\" class=\"CitationRef\"\u003e153\u003c/span\u003e, \u003cspan citationid=\"CR154\" class=\"CitationRef\"\u003e154\u003c/span\u003e, \u003cspan citationid=\"CR155\" class=\"CitationRef\"\u003e155\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study's findings indicate that a surgical duration exceeding three hours is a risk factor for surgical site infections in patients with colorectal cancer, aligning with Katsuno's research. It has been shown that the risk of postoperative incision infection in colorectal cancer increases with the length of the surgery [\u003cspan citationid=\"CR156\" class=\"CitationRef\"\u003e156\u003c/span\u003e, \u003cspan citationid=\"CR157\" class=\"CitationRef\"\u003e157\u003c/span\u003e, \u003cspan citationid=\"CR158\" class=\"CitationRef\"\u003e158\u003c/span\u003e, \u003cspan citationid=\"CR159\" class=\"CitationRef\"\u003e159\u003c/span\u003e]. Extended surgical times are often associated with increased blood loss, potentially leading to tissue hypoxia [\u003cspan citationid=\"CR160\" class=\"CitationRef\"\u003e160\u003c/span\u003e, \u003cspan citationid=\"CR161\" class=\"CitationRef\"\u003e161\u003c/span\u003e, \u003cspan citationid=\"CR162\" class=\"CitationRef\"\u003e162\u003c/span\u003e]. Longer surgeries inevitably carry a higher risk of bleeding and increased blood loss, reducing the body's resistance and inducing infection [\u003cspan citationid=\"CR163\" class=\"CitationRef\"\u003e163\u003c/span\u003e]. The longer the surgery, the more energy the patient expends, raising the risk of exogenous infection and, thereby, the risk of postoperative incision infection [\u003cspan citationid=\"CR164\" class=\"CitationRef\"\u003e164\u003c/span\u003e, \u003cspan citationid=\"CR165\" class=\"CitationRef\"\u003e165\u003c/span\u003e, \u003cspan citationid=\"CR166\" class=\"CitationRef\"\u003e166\u003c/span\u003e]. Prolonged surgical duration also means the sterile environment within the abdomen is exposed to air for a longer time [\u003cspan citationid=\"CR167\" class=\"CitationRef\"\u003e167\u003c/span\u003e, \u003cspan citationid=\"CR168\" class=\"CitationRef\"\u003e168\u003c/span\u003e, \u003cspan citationid=\"CR169\" class=\"CitationRef\"\u003e169\u003c/span\u003e]. Even in an operation meeting standard requirements, air cleanliness decreases with extended surgical times, increasing the probability of local bacterial contamination [\u003cspan citationid=\"CR170\" class=\"CitationRef\"\u003e170\u003c/span\u003e, \u003cspan citationid=\"CR171\" class=\"CitationRef\"\u003e171\u003c/span\u003e, \u003cspan citationid=\"CR172\" class=\"CitationRef\"\u003e172\u003c/span\u003e]. The wound's exposure to air also increases, leading to a higher bacterial count at the incision site and increasing the possibility of tissue cell destruction. Longer surgeries, extended exposure to tissue traction, and prolonged use of surgical energy devices can damage tissues. Moreover, extended anesthesia can adversely affect the patient's immune function. The body's immunity diminishes as anesthesia duration and intraoperative blood loss increase. The length of the surgery is not only related to the patient's physical condition but also largely depends on the surgeon's skill and proficiency in the operation. Thus, an increased rate of postoperative incision infection indicates that more complex, challenging, and traumatic surgeries with longer durations lead to higher infection rates [\u003cspan citationid=\"CR173\" class=\"CitationRef\"\u003e173\u003c/span\u003e, \u003cspan citationid=\"CR174\" class=\"CitationRef\"\u003e174\u003c/span\u003e]. Therefore, enhancing the surgical skills and intraoperative proficiency of surgeons, reducing surgical trauma, shortening surgical duration, and lowering the incidence of incision infections is paramount. Zheng Hui's multivariate analysis of 2308 patients showed that surgical duration (OR\u0026thinsp;=\u0026thinsp;1.007, 95% CI: 1.002\u0026thinsp;~\u0026thinsp;1.012) is an independent risk factor for incision infection [\u003cspan citationid=\"CR175\" class=\"CitationRef\"\u003e175\u003c/span\u003e]. Thus, effectively controlling surgical duration can significantly reduce the incidence of incision infections [\u003cspan citationid=\"CR176\" class=\"CitationRef\"\u003e176\u003c/span\u003e, \u003cspan citationid=\"CR177\" class=\"CitationRef\"\u003e177\u003c/span\u003e, \u003cspan citationid=\"CR178\" class=\"CitationRef\"\u003e178\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on the analysis of various risk factors, future clinical practices can implement the following strategies to prevent postoperative incision infections in patients with colorectal cancer:\u003c/p\u003e \u003cp\u003e(1) Preoperative: Implement infection prevention measures and avoid scheduling surgeries during summer. For diabetic patients, intensify monitoring and control of blood glucose levels and use insulin judiciously. Surgery should proceed only when blood glucose levels are within normal ranges. For elderly patients, complications should be vigilantly monitored and actively managed preoperatively. Additionally, patients' nutritional status should be assessed, and timely nutritional support should be provided to those with low serum albumin to ensure balanced daily nutrient intake and optimal preoperative nutrition.\u003c/p\u003e \u003cp\u003e(2) Intraoperative: Adhere to standard sterile procedures, minimize electrosurgical use in patients with thick adipose layers, and adjust the electrosurgical power as necessary. Inactive fatty tissue should be rinsed with saline during incision closure. Moreover, surgical preparations should be meticulously planned, requiring close cooperation among medical staff to enhance procedural proficiency and actively manage surgical duration. When appropriate, consider laparoscopic surgery for its reduced patient trauma and lower postoperative incision infection rates, taking into account the patient's specific health status and condition.\u003c/p\u003e \u003cp\u003e(3) Postoperative: Monitor changes in patient vitals, replenish energy promptly as needed, and encourage high-fiber and protein-rich foods to boost nutrition and maintain electrolyte balance. Pay attention to changes in the nature, volume, and color of drainage fluid, replace drainage bags timely to prevent incision-related infections, and regularly change wound dressings to prevent bacterial growth and infection.\u003c/p\u003e \u003cp\u003eDespite our study's rigorous design and execution, it has limitations. First, the significant heterogeneity among studies may affect the robustness of our conclusions, although sensitivity analysis and publication bias assessment have been conducted to ensure the reliability of the results. Second, the quality of included studies varies, and despite rigorous evaluation using the Cochrane risk of bias tool and NOS scoring system, the impact of low-quality studies must be partially ruled out. Additionally, language and database search limitations might have led to selection bias due to potentially relevant studies needing to be included.\u003c/p\u003e \u003cp\u003eFuture research should further explore the causal relationships between these risk factors and postoperative incision infections in colorectal cancer and how they interact with other potential risk factors. Moreover, as medical technology advances, new surgical techniques and postoperative management strategies may influence the risk of postoperative incision infections in colorectal cancer. Therefore, ongoing research and updated meta-analyses must ensure our conclusions reflect the latest scientific evidence.\u003c/p\u003e \u003cp\u003eIn summary, this study provides critical insights into the risk factors for postoperative incision infection in colorectal cancer, emphasizing the importance of comprehensive assessment and management of these risk factors in clinical practice. By early identification and intervention of these risk factors, the incidence of postoperative incision infections in colorectal cancer patients can potentially be reduced, thereby improving patient prognosis and quality of life. Future research should aim to explore additional potential risk factors and evaluate the effectiveness of various prevention and management strategies to optimize postoperative care for colorectal cancer patients further.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo need.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by National Natural Science Foundation of China (No. 82373336).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data can be provided as needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJia Li contributed to conceptualization, investigation, methodology, and writing of the original draft. Zhao Huacai was involved in investigation, methodology, supervision, visualization, and writing the original draft. Liu Jia participated in data curation, methodology, and writing the original draft. All authors have reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLu L, Mullins CS, Schafmayer C, Zei\u0026szlig;ig S, Linnebacher M. A global assessment of recent trends in gastrointestinal cancer and lifestyle-associated risk factors. Cancer Commun (Lond). 2021;41(11):1137-1151. doi:10.1002/cac2.12220\u003c/li\u003e\n\u003cli\u003eHang D, Shen H. Sex Hormone and Colorectal Cancer: The Knowns and Unknowns. Cancer Epidemiol Biomarkers Prev. 2021;30(7):1302-1304. doi:10.1158/1055-9965.EPI-21-0472\u003c/li\u003e\n\u003cli\u003eOhno Y, Mazaki J, Udo R, et al. Preliminary Evaluation of a Novel Artificial Intelligence-based Prediction Model for Surgical Site Infection in Colon Cancer. 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Lancet Digit Health. 2022;4(1):e8-e17. doi:10.1016/S2589-7500(21)00215-6\u003c/li\u003e\n\u003cli\u003eZhu J, Lian J, Xu B, et al. Neoadjuvant immunotherapy for colorectal cancer: Right regimens, right patients, right directions?. Front Immunol. 2023;14:1120684. Published 2023 Mar 6. doi:10.3389/fimmu.2023.1120684\u003c/li\u003e\n\u003cli\u003eYamada K, Imaizumi J, Kato R, Takada T, Ojima H. Streamlining robotic-assisted abdominoperineal resection. World J Surg Oncol. 2023;21(1):392. Published 2023 Dec 20. doi:10.1186/s12957-023-03260-x\u003c/li\u003e\n\u003cli\u003eMachairas N, Dorovinis P, Kykalos S, et al. Simultaneous robotic-assisted resection of colorectal cancer and synchronous liver metastases: a systematic review. J Robot Surg. 2021;15(6):841-848. doi:10.1007/s11701-021-01213-8\u003c/li\u003e\n\u003cli\u003eKim TY, Cho JH, Choi YS, Kim HK, Kim JG, Shim YM. Surgical Strategy for Primary Colorectal Carcinoma and Synchronous Pulmonary Metastasis Resection. J Chest Surg. 2022;55(1):37-43. doi:10.5090/jcs.21.118\u003c/li\u003e\n\u003cli\u003eZhan Q, Jiang C. Chromoendoscopy Plus Mucosal Resection Versus Conventional Electrocoagulation for Intestinal Polyps in Children: Two Case Series. J Laparoendosc Adv Surg Tech A. 2018;28(11):1403-1407. doi:10.1089/lap.2017.0633\u003c/li\u003e\n\u003cli\u003eGao J, Wang Y, Song J, Li Z, Ren J, Wang P. Negative pressure wound therapy for surgical site infections: A systematic review and meta-analysis [published correction appears in J Adv Nurs. 2022 Jun;78(6):1848]. J Adv Nurs. 2021;77(10):3980-3990. doi:10.1111/jan.14876\u003c/li\u003e\n\u003cli\u003eSlagter JS, Outmani L, Tran KTCK, Ijzermans JNM, Minnee RC. Robot-assisted kidney transplantation as a minimally invasive approach for kidney transplant recipients: A systematic review and meta-analyses. Int J Surg. 2022;99:106264. doi:10.1016/j.ijsu.2022.106264\u003c/li\u003e\n\u003cli\u003eTheodorou C, Simpson GS, Walsh CJ. Theatre ventilation. Ann R Coll Surg Engl. 2021;103(3):151-154. doi:10.1308/rcsann.2020.7146\u003c/li\u003e\n\u003cli\u003eNiederman MS, Baron RM, Bouadma L, et al. Initial antimicrobial management of sepsis. Crit Care. 2021;25(1):307. Published 2021 Aug 26. doi:10.1186/s13054-021-03736-w\u003c/li\u003e\n\u003cli\u003eOjima T, Nakamura M, Hayata K, et al. Short-term Outcomes of Robotic Gastrectomy vs Laparoscopic Gastrectomy for Patients With Gastric Cancer: A Randomized Clinical Trial. JAMA Surg. 2021;156(10):954-963. doi:10.1001/jamasurg.2021.3182\u003c/li\u003e\n\u003cli\u003eFeroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P. Comparison of the Efficacy of the Various Treatment Modalities in the Management of Perianal Crohn\u0026apos;s Fistula: A Review. Cureus. 2020;12(12):e11882. Published 2020 Dec 3. doi:10.7759/cureus.11882\u003c/li\u003e\n\u003cli\u003eSolaini L, Cavaliere D, Avanzolini A, Rocco G, Ercolani G. Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis. J Robot Surg. 2022;16(4):775-781. doi:10.1007/s11701-021-01312-6\u003c/li\u003e\n\u003cli\u003eCuk P, Kj\u0026aelig;r MD, Mogensen CB, Nielsen MF, Pedersen AK, Elleb\u0026aelig;k MB. Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis. Surg Endosc. 2022;36(1):32-46. doi:10.1007/s00464-021-08782-7\u003c/li\u003e\n\u003cli\u003eMarescaux J, Seeliger B. Robotic surgery: a time of change. Updates Surg. 2023;75(4):793-794. doi:10.1007/s13304-023-01546-z\u003c/li\u003e\n\u003cli\u003eS\u0026aacute;nchez-Vel\u0026aacute;zquez P, Pera M, Jim\u0026eacute;nez-Toscano M, et al. Postoperative intra-abdominal infection is an independent prognostic factor of disease-free survival and disease-specific survival in patients with stage II colon cancer. Clin Transl Oncol. 2018;20(10):1321-1328. doi:10.1007/s12094-018-1866-8\u003c/li\u003e\n\u003cli\u003eAllen N, Adam M, O\u0026apos;Regan G, et al. Outpatient parenteral antimicrobial therapy (OPAT) for aortic vascular graft infection; a five-year retrospective evaluation. BMC Infect Dis. 2021;21(1):670. Published 2021 Jul 9. doi:10.1186/s12879-021-06373-4\u003c/li\u003e\n\u003cli\u003eGong Y, Wang X, Li N, et al. A Partially Randomized Patient Preference Trial to Assess the Quality of Life and Patency Rate After Minimally Invasive Cardiac Surgery-Coronary Artery Bypass Grafting: Design and Rationale of the MICS-CABG PRPP Trial. Front Cardiovasc Med. 2022;9:804217. Published 2022 Apr 25. doi:10.3389/fcvm.2022.804217\u003c/li\u003e\n\u003cli\u003eTserenpuntsag B, Haley V, Van Antwerpen C, et al. Surgical site infection risk factors identified for patients undergoing colon procedures, New York State 2009-2010. Infect Control Hosp Epidemiol. 2014;35(8):1006-1012. doi:10.1086/677156\u003c/li\u003e\n\u003cli\u003eRossiter N. Levelling up: prioritisation of global health. Eur J Orthop Surg Traumatol. 2023;33(3):559-563. doi:10.1007/s00590-022-03394-w\u003c/li\u003e\n\u003cli\u003eDwan K, Kirkham J, Paton RW, Morley E, Newton AW, Perry DC. Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age. Cochrane Database Syst Rev. 2022;10(10):CD012717. Published 2022 Oct 10. doi:10.1002/14651858.CD012717.pub2\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Characteristics and quality evaluation of included documents.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003e\u003cstrong\u003eResearch Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase Group/Exposure Group (Example)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl Group/Unexposed Group (Example)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk Factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNos Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eNi et al.\u003c/p\u003e\n \u003cp\u003e(DOI:10.3969/j.issn.1009-7147.2022.05.052)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eDeng et al.\u003c/p\u003e\n \u003cp\u003e(Deng Zhenwei,Chen Guohao,Tang Yuxin et al. Analysis of prognostic factors of incision infection after colorectal cancer surgery[J]. China Prescription Drugs,2022,20(06):126-128.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75%\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003e1.2.5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eWang et al.\u003c/p\u003e\n \u003cp\u003e(WANG Yongli. Factors associated with postoperative incision infection in colorectal cancer patients and nursing intervention[J]. Clinical Research,2021,29(12):160-163.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75%\"\u003e\n \u003cp\u003e837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003e1.2.5.6.7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eZhao et al.\u003c/p\u003e\n \u003cp\u003e(DOI: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;10.13463/j.cnki.cczyy.2021.04.035)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75%\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003e2.5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eAtsushi et al.\u003c/p\u003e\n \u003cp\u003e(DOI:10.1007/s12672-021-00396-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eJapan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\"\u003e\n \u003cp\u003e3075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eLiu et al.\u003cbr\u003e(DOI:10.3969/j.issn.1674-4985.2020.19.040)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\"\u003e\n \u003cp\u003e660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eMa et al.\u003c/p\u003e\n \u003cp\u003e(DOI: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;10.16073/j.cnki.cjcpt.2020.05.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\"\u003e\n \u003cp\u003e1.2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eWu et al.\u003c/p\u003e\n \u003cp\u003e(DOI:CNKI:SUN:ZHYY.0.2018-13-025)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\"\u003e\n \u003cp\u003e1.4.5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eLi et al.\u003c/p\u003e\n \u003cp\u003e(DOI:10.3969/j.issn.1000-1174.2020.11.024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\"\u003e\n \u003cp\u003e2.4.5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eLiang et al.\u003c/p\u003e\n \u003cp\u003e(DOI: \u0026nbsp; 10.19668/j.cnki.issn1674-0491.2018.03.006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.25%\"\u003e\n \u003cp\u003eZhu et al.\u003c/p\u003e\n \u003cp\u003e(DOI:10.11816/cn.ni.2015-135784)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\"\u003e\n \u003cp\u003eCase control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.708333333333332%\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\"\u003e\n \u003cp\u003e1.2.3.5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.25%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: 1: BMI \u0026ge; 25 kg/m\u003csup\u003e2\u003c/sup\u003e; 2: diabetes; 3: placing subcutaneous drainage; 4. Preoperative low albumin; 5 surgical methods; 6: malnutrition; 7: age; 8: The duration of operation is \u0026gt; 3h.\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Overview of heterogeneity tests and effect model selection for various risk factors.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" rowspan=\"2\" style=\"width: 18.1797%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of documents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" colspan=\"2\" style=\"width: 22.4453%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeterogeneity test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" rowspan=\"2\" style=\"width: 24.2363%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55%\" style=\"width: 11.6094%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI\u003csup\u003e2\u003c/sup\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45%\" style=\"width: 10.7656%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\"\u003e\n \u003cp\u003eBMI\u0026ge;24kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" style=\"width: 18.1797%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" style=\"width: 11.6094%;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" style=\"width: 10.7656%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" style=\"width: 24.2363%;\"\u003e\n \u003cp\u003eRandom effect model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" style=\"width: 18.1797%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" style=\"width: 11.6094%;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" style=\"width: 10.7656%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" style=\"width: 24.2363%;\"\u003e\n \u003cp\u003eRandom effect model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\"\u003e\n \u003cp\u003ePreoperative low albumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" style=\"width: 18.1797%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" style=\"width: 11.6094%;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" style=\"width: 10.7656%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" style=\"width: 24.2363%;\"\u003e\n \u003cp\u003eRandom effect model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\"\u003e\n \u003cp\u003eOperation mode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" style=\"width: 18.1797%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" style=\"width: 11.6094%;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" style=\"width: 10.7656%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" style=\"width: 24.2363%;\"\u003e\n \u003cp\u003eRandom effect model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\"\u003e\n \u003cp\u003eMalnutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" style=\"width: 18.1797%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" style=\"width: 11.6094%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" style=\"width: 10.7656%;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" style=\"width: 24.2363%;\"\u003e\n \u003cp\u003eFixed effect model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\"\u003e\n \u003cp\u003eOperation duration \u0026gt; 3h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.711340206185568%\" style=\"width: 18.1797%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" style=\"width: 11.6094%;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.278350515463918%\" style=\"width: 10.7656%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.61855670103093%\" style=\"width: 24.2363%;\"\u003e\n \u003cp\u003eRandom effect model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: I\u003csup\u003e2\u003c/sup\u003e, I-squared statistic for heterogeneity; P, P-value for heterogeneity; the I\u003csup\u003e2\u003c/sup\u003e statistic describes the percentage of total variation across studies that is due to heterogeneity rather than chance. A higher I\u003csup\u003e2\u003c/sup\u003e value indicates greater heterogeneity. The P-value tests the null hypothesis that the studies are homogeneous. The effect model column indicates the statistical model applied for the meta-analysis based on the heterogeneity test results: a Random effect model is used when significant heterogeneity is detected, and a Fixed effect model is employed when heterogeneity is low or not statistically significant.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Colorectal Cancer, Postoperative Incision Infection, Risk Factors, Meta-Analysis, Laparoscopic Surgery, Patient Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-4262701/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4262701/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePostoperative incision infections are a significant concern in colorectal cancer surgery, impacting patient recovery and well-being. Identification of key risk factors for infection following colorectal cancer surgery is crucial for improving patient outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA meta-analytical approach was employed to analyze studies published from January 2015 to December 2022, focusing on variables such as body mass index, diabetes, albumin levels, malnutrition, and surgical duration to assess their association with postoperative infection incidence in colorectal cancer patients.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAnalysis of eleven high-quality studies revealed that elevated body mass index, diabetes, low albumin levels, malnutrition, and longer surgical durations were linked to an increased risk of postoperative incision infections. Conversely, laparoscopic procedures demonstrated potential for reducing infection risks.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eEffective preoperative risk assessment and management are vital in preventing postoperative incision infections in colorectal cancer patients. These findings offer actionable insights for clinicians to optimize patient prognoses and enhance overall quality of life outcomes.\u003c/p\u003e","manuscriptTitle":"New Insights into Risk Factors for Postoperative Infections in Colorectal Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 18:24:51","doi":"10.21203/rs.3.rs-4262701/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"26e9a906-9828-4a28-ae98-9c99c5892b8e","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-18T06:56:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-11 18:24:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4262701","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4262701","identity":"rs-4262701","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}