surgical site infections and warm weather 815
been reported as 84.1% and 97.3%, respectively.44 Third, we have only inpatient data, and some SSIs are treated in out- patient settings. Practice patterns for admitting patients with SSIs may differ during summer months (eg, due to vacation schedules). Fourth, we only consider weather data aggregated to a monthly level. Although we have more granular weather data, the NIS dataset only provides monthly data. More granular discharge data would allow us to estimate the contributions of weather patterns to the seasonality of SSIs more precisely. Finally, we found a small increase in SSI cases over time (2% per year) in contrast with reports of falling SSI rates.45,46 However, we only considered inpatient SSIs making it difficult to compare our findings with other reports. Despite these limitations, we have demonstrated that the
incidence of hospitalizations for SSIs is seasonal and that the seasonality of SSIs can, at least in part, be explained by weather patterns. Our results suggest that further investigation is needed with more granular data including exact surgery dates and specific procedures. Such work will help determine whe- ther shifting the timing of some surgeries away from peak SSI months can help reduce SSIs in patients with specific procedures.
acknowledgments
Financial support: L.A.P. received support from the National Heart, Lung and Blood Institute (grant no. K25 HL 122305). P.M.P. received support from the University of Iowa Health Ventures’ Signal Center for Health Innovation. Potential conflicts of interest: All authors report no conflicts of interest rele-
vant to this article. Address correspondence to Philip M. Polgreen, MD, University of
Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242 (
philip-polgreen@uiowa.edu).
references
1. Procedure-associated module: surgical site infection (SSI) event. Centers for Disease Control and Prevention website. http://www.
cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Published 2016. Accessed October 15, 2016.
2. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(Suppl 2): S66–S88.
3. Magill SS, Hellinger W, Cohen J, et al. Prevalence of healthcare- associated infections in acute care hospitals in Jacksonville, Florida. Infect Control Hosp Epidemiol 2012;33:283–291.
4. Sandy-Hodgetts K, Leslie GD, Lewin G, Hendrie D, Carville K. Surgical wound dehiscence in an Australian community nursing service: time and cost to healing. J Wound Care 2016;25:377–383.
5. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387–397.
6. Dohmen PM. Antibiotic resistance in common pathogens rein- forces the need to minimise surgical site infections. J Hosp Infect 2008;70(Suppl 2):15–20.
7. Leaper DJ, van Goor H, Reilly J, et al. Surgical site infection—a European perspective of incidence and economic burden. Int Wound J 2004;1:247–273.
8. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.
9. Astagneau P, Rioux C, Golliot F, Brucker G. Morbidity and mortality associated with surgical site infections: results from the 1997–1999 INCISO surveillance. J Hosp Infect 2001;48:267–274.
10. Ramkumar PN, Chu CT, Harris JD, et al. Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis. Am J Orthoped (Belle Mead, NJ) 2015;44:397–405.
11. Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183–189.
12. Durkin MJ, Dicks KV, Baker AW, et al. Seasonal variation of common surgical site infections: does season matter? Infect Control Hosp Epidemiol 2015;36:1011–1016.
13. Beitsch P, Balch C. Operative morbidity and risk factor assess- ment in melanoma patients undergoing inguinal lymph node dissection. Am J Surg 1992;164:462–466.
14. Harrop JS, Styliaras JC, Ooi YC, Radcliff KE, Vaccaro AR, Wu C. Contributing factors to surgical site infections. J Am Acad Orthopaed Surg 2012;20:94–101.
15. Lilienfeld DE, Vlahov D, Tenney JH, McLaughlin JS. Obesity anddiabetes as risk factors for postoperative wound infections after cardiac surgery. Am J Infect Control 1988;16:3–6.
16. Nystrom PO, Jonstam A, Hojer H, Ling L. Incisional infection after colorectal surgery in obese patients. Acta chirurgica Scand 1987;153:225–227.
17. Mishriki SF, Law DJ, Jeffery PJ. Factors affecting the incidence of postoperative wound infection. J Hosp Infect 1990;16:223–230.
18. Casey J, Flinn WR, Yao JS, Fahey V, Pawlowski J, Bergan JJ. Correlation of immune and nutritional status with wound complications in patients undergoing vascular operations. Surgery 1983;93:822–827.
19. Meyer E, Weitzel-Kage D, Sohr D, Gastmeier P. Impact of department volume on surgical site infections following arthro- scopy, knee replacement or hip replacement. BMJ Qual Safety 2011;20:1069–1074.
20. Muilwijk J, van den Hof S, Wille JC. Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the Dutch nosocomial infection surveillance network. Infect Control Hosp Epidemiol 2007;28:557–563.
21. Hughes JM, Culver DH, White JW, et al. Nosocomial infection surveillance, 1980–1982. MMWR CDC Surveil Sum 1983;32: 1ss–16ss.
22. Durkin MJ, Dicks KV, Baker AW, et al. Postoperative infection in spine surgery: does the month matter? J Neurosurg Spine 2015;23:128–134.
23. Kane P, Chen C, Post Z, Radcliff K, Orozco F, Ong A. Seasonality of infection rates after total joint arthroplasty. Orthopedics 2014;37:e182–e186.
24. Sagi HC, Cooper S, Donahue D, Marberry S, Steverson B. Seasonal variations in posttraumatic wound infections after
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136
