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Infections after pediatric ambulatory surgery: Incidence and risk factors

Published online by Cambridge University Press:  30 January 2019

Jeffrey S. Gerber ,
Rachael K. Ross ,
Julia E. Szymczak ,
Rui Xiao ,
A. Russell Localio ,
Robert W. Grundmeier ,
Susan L Rettig ,
Eva Teszner ,
Doug A. Canning  and
Susan E. Coffin
Jeffrey S. Gerber*
Affiliation:
Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Rachael K. Ross
Affiliation:
Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Julia E. Szymczak
Affiliation:
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Rui Xiao
Affiliation:
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
A. Russell Localio
Affiliation:
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Robert W. Grundmeier
Affiliation:
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Susan L Rettig
Affiliation:
Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Eva Teszner
Affiliation:
Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Doug A. Canning
Affiliation:
Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Jeffrey S. Gerber MD, PhD, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 10364, Philadelphia, PA 9146-2305. E-mail: [email protected]
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Abstract

Objective

To describe the epidemiology of surgical site infections (SSIs) after pediatric ambulatory surgery.

Design

Observational cohort study with 60 days follow-up after surgery.

Setting

The study took place in 3 ambulatory surgical facilities (ASFs) and 1 hospital-based facility in a single pediatric healthcare network.

Participants

Children <18 years undergoing ambulatory surgery were included in the study. Of 19,777 eligible surgical encounters, 8,502 patients were enrolled.

Methods

Data were collected through parental interviews and from chart reviews. We assessed 2 outcomes: (1) National Healthcare Safety Network (NHSN)–defined SSI and (2) evidence of possible infection using a definition developed for this study.

Results

We identified 21 NSHN SSIs for a rate of 2.5 SSIs per 1,000 surgical encounters: 2.9 per 1,000 at the hospital-based facility and 1.6 per 1,000 at the ASFs. After restricting the search to procedures completed at both facilities and adjustment for patient demographics, there was no difference in the risk of NHSN SSI between the 2 types of facilities (odds ratio, 0.7; 95% confidence interval, 0.2–2.3). Within 60 days after surgery, 404 surgical patients had some or strong evidence of possible infection obtained from parental interview and/or chart review (rate, 48 SSIs per 1,000 surgical encounters). Of 306 cases identified through parental interviews, 176 cases (57%) did not have chart documentation. In our multivariable analysis, older age and black race were associated with a reduced risk of possible infection.

Conclusions

The rate of NHSN-defined SSI after pediatric ambulatory surgery was low, although a substantial additional burden of infectious morbidity related to surgery might not have been captured by standard surveillance strategies and definitions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 150 - 157
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Gerber JS, et al. (2019). Infections after pediatric ambulatory surgery: Incidence and risk factors. Infection Control & Hospital Epidemiology 2019, 40, 150–157. doi: 10.1017/ice.2018.211

References

1. Magill, SS, Wilson, LE, Thompson, DL, et al. Emerging Infections Program Hospital Prevalence Survey Team: reduction in the prevalence of healthcare-associated infections in US acute-care hospitals, 2015 vs 2011. Open Forum Infect Dis 2017;4 : S49.Google Scholar
2. The Society for Hospital Epidemiology of America, The Association for Practitioners in Infection Control, The Centers for Disease Control, and The Surgical Infection Society. Consensus paper on the surveillance of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:599–605.Google Scholar
3. Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Platt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9:196–203.Google Scholar
4. Hall, MJ, Schwartzman, A, Zhang, J, Liu, X. Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010. Washington, DC: US Department of Health and Human Services; 2017.Google Scholar
5. Somme, S, Bronsert, M, Morrato, E, Ziegler, M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 2013;132:e1466–e1472.Google Scholar
6. Hyder, JA, Hanson, KT, Storlie, CB, et al. Safety of overlapping surgery at a high-volume referral center. Ann Surg 2018;267:e91–e92.Google Scholar
7. Schaffzin, JK, Harte, L, Marquette, S, et al. Surgical site infection reduction by the solutions for patient safety hospital engagement network. Pediatrics 2015;136:e1353–e1360.Google Scholar
8. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783–805.Google Scholar
9. Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) Patient Safety Component Key Terms. Atlanta, GA: CDC; 2010.Google Scholar
10. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
11. Rinke, ML, Jan, D, Nassim, J, Choi, J, Choi, SJ. Surgical site infections following pediatric ambulatory surgery: an epidemiologic analysis. Infect Control Hosp Epidemiol 2016;37:931–938.Google Scholar
12. Owens, PL, Barrett, ML, Raetzman, S, Maggard-Gibbons, M, Steiner, CA. Surgical site infections following ambulatory surgery procedures. JAMA 2014;311:709–716.Google Scholar
13. Kulaylat, AN, Engbrecht, BW, Rocourt, DV, et al. Measuring surgical site infections in children: comparing clinical, electronic, and administrative data. J Am Coll Surg 2016;222:823–830.Google Scholar
14. Dicks, KV, Lewis, SS, Durkin, MJ, et al. Surveying the surveillance: surgical site infections excluded by the January 2013 updated surveillance definitions. Infect Control Hosp Epidemiol 2014;35:570–573.Google Scholar
15. Costello, JM, Graham, DA, Morrow, DF, et al. Risk factors for surgical site infection after cardiac surgery in children. Ann Thorac Surg 2010;89:1833–1841.Google Scholar
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