Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-19T03:11:13.154Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiology of Surgical-Site Infections Diagnosed After Hospital Discharge A Prospective Cohort Study

Published online by Cambridge University Press:  02 January 2015

Miguel Delgado-Rodríguez ,
Antonio Gómez-Ortega ,
Maria Sillero-Arenas  and
Javier Llorca
Miguel Delgado-Rodríguez*
Affiliation:
Division of Preventive Medicine and Public Health, School of Medicine, University of Cantabria, Santander
Antonio Gómez-Ortega
Affiliation:
Service of General Surgery, General Hospital Ciudad de Jaén, Jaén, Spain
Maria Sillero-Arenas
Affiliation:
Division of Health Programs, Provincial Office for Health, Jaén, Spain
Javier Llorca
Affiliation:
Division of Preventive Medicine and Public Health, School of Medicine, University of Cantabria, Santander
*
Division of Preventive Medicine and Public Health, Department of Health Sciences, University of Jaén, Building B-3, 23071-Jaén, Spain
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To study postoperative infections in hospital and after discharge, and to identify the risk factors for such infections.

Design:

Prospective cohort study, with telephone follow-up for 1 month after hospital discharge.

Setting:

The general surgery service of a tertiary hospital in Spain.

Main Outcome Measure:

In-hospital and postdischarge surgical-site infection (SSI), always confirmed by a physician.

Results:

Of the 1,506 patients initially enrolled, 29 died during hospital stay, and 33 were lost to postdischarge follow-up. An SSI was identified prior to discharge in 123 patients and after discharge in 103. For several variables (age, serum albumin, glycemia, lengths of preoperative and postoperative hospital stay, etc), there were no differences between patients with postdischarge SSI and noninfected patients; however, there were differences detected between patients with postdischarge SSI and in-hospital SSI, as well as between patients with in-hospital SSI and noninfected patients. The analysis of risk factors showed that most predictors for in-hospital SSI did not behave in the same manner for postdischarge SSI. Stepwise logistic regression only identified chemoprophylaxis, age (advanced age was a preventive factor), and body mass index as independent risk factors for postdischarge SSI. Differences in risk factors between in-hospital and postdischarge SSIs remained even after controlling for time from operation to diagnosis.

Conclusions:

Most predictors of in-hospital SSI were not predictors of postdischarge SSI.

Type
Medical News
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 1 , January 2001 , pp. 24 - 30
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Burns, SJ, Dippe, SE. Postoperative wound infections detected during hospitalization and after discharge in a community hospital. Am J Infect Control 1982;10:60–65.Google Scholar
2.Rosendorf, LL, Octavio, J, Estes, JP. Effect of method of postdischarge wound infection surveillance on reported infection rates. Am J Infect Control 1983;11:226–229.Google Scholar
3.Brown, RB, Bradley, S, Opitz, E, Cipriani, D, Pieczrks, R, Sand, M. Surgical wound infections documented after hospital discharge. Am J Infect Control 1987;15:54–58.Google Scholar
4.Reimer, K, Gleed, C, Nicolle, LE. The impact of postdischarge infection on surgical wound infection rates. Infect Control 1987;8:237–240.Google Scholar
5.Law, DSW, Mishriki, SF, Jeffrey, PJ. The importance of surveillance after discharge from hospital in the diagnosis of postoperative wound infection. Ann R Coll Surg Engl 1990;72:207–209.Google ScholarPubMed
6.Manian, FA, Meyer, L. Comprehensive surveillance of surgical wound infections in outpatient and inpatient surgery. Infect Control Hosp Epidemiol 1990;11:515–520.CrossRefGoogle ScholarPubMed
7.Weigelt, JA, Dryer, D, Haley, RW. The necessity and efficiency of wound surveillance after discharge. Arch Surg 1992;127:77–82.Google Scholar
8.Ferraz, EM, Ferraz, AA, Coelho, HS, Pereira Viana, VP, Sobral, SM, Vasconcelos, MD, et al. Postdischarge surveillance for nosocomial wound infection: does judicious monitoring find cases? Am J Infect Control 1995;23:290–294.Google Scholar
9.Simchen, E, Wax, Y, Galai, N, Israeli, A. Discharge from hospital and its effect on surgical wound infections. The Israeli Study of Surgical Infections (ISSI). J Clin Epidemiol 1992;45:1155–1163.Google Scholar
10.Medina-Cuadros, M, Sillero-Arenas, M, Martínez Gallego, G, Delgado-Rodríguez, M. Surgical wound infections diagnosed after discharge from hospital. Epidemiological differences with in-hospital infections. Am J Infect Control 1996;24:421–428.Google Scholar
11.Lecuona, M, Torres-Lana, A, Delgado-Rodríguez, M, Llorca, J, Sierra, A. Risk factors for surgical site infections diagnosed after hospital discharge. J Hosp Infect 1998;39:71–74.Google Scholar
12.Owens, W, Felts, J, Spitznagel, E. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978;49:239–243.Google Scholar
13.McCabe, WR, Jackson, GG. Gram-negative bacteremia, II: clinical, laboratory and therapeutic observations. Arch Intern Med 1962;110:856–864.Google Scholar
14.Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infection: a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206–215.Google Scholar
15.Culver, DH, Horan, RC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(suppl 3B):152S–157S.Google Scholar
16.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. Centers for Diseases Control (CDC) definitions for nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.CrossRefGoogle ScholarPubMed
17.Delgado-Rodríguez, M, Martínez Gallego, G, Medina Cuadros, M, Sillero Arenas, M. Nosocomial infections in surgical patients: comparison of two measures of intrinsic patient risk. Infect Control Hosp Epidemiol 1997;18:19–23.CrossRefGoogle ScholarPubMed
18.Mickey, RM, Greenland, S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–137.Google Scholar
19.Garibaldi, RA, Cushiong, D, Lerer, T. Risk factors for postoperative infection. Am J Med 1991;91(suppl 3B):158S–163S.CrossRefGoogle ScholarPubMed
20.Mayhall, CG. Surgical infections including burns. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 2nd ed. Baltimore, MD: Williams & Wilkins; 1993:614–664.Google Scholar
21.Ferraz, EM, Bacelar, TS, Aguiar, JLA, Ferraz, AAB, Pagnossin, G, Batista, JEM. Wound infection rates in clean surgery: a potentially misleading risk classification. Infect Control Hosp Epidemiol 1992;13:457–462.Google Scholar
22.Nichols, RL. Wound infection rates following clean operative procedures: can we assume them to be low? Infect Control Hosp Epidemiol 1992;13:455–456.Google Scholar