Infection Control & Hospital Epidemiology (2019), 40, 150–157 doi:10.1017/ice.2018.211
Original Article
Infections after pediatric ambulatory surgery: Incidence and risk factors
Jeffrey S. Gerber MD, PhD1,2,3, Rachael K. Ross MPH1, Julia E. Szymczak PhD3, Rui Xiao PhD3, A. Russell Localio PhD, JD3, Robert W. Grundmeier MD2,4, Susan L Rettig RN5, Eva Teszner RN5,
Doug A. Canning MD6,7 and Susan E. Coffin MD MPH1,2 1Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, 2Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, 3Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 4Department of Biomedical and Health Informatics, Children’s Hospital
of Philadelphia, Philadelphia, Pennsylvania, 5Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, 6Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania and 7Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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.
(Received 15 May 2018; accepted 26 July 2018)
Surgical site infections (SSIs) are among the most commonly reported healthcare-associated infection in adults and children,1 and they are associated with substantial morbidity and cost.2,3 However, SSI epidemiology, outcomes, and prevention research has primarily examined inpatient surgery in adults. Although children undergo nearly 3 million ambulatory surgical procedures annually,4 few large studies have examined the incidence of and risk factors for SSIs in this population. The case mix of adult and pediatric surgeries markedly differs,
suggesting that we cannot generalize all findings derived from adult studies to pediatric patients.5,6 Furthermore, our under- standing of the epidemiology of a pediatric SSI is limited because
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:
gerberj@chop.edu
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
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
most studies have focused on a small group of surgical procedures that have been deemed “high risk,” such as repair of complex congenital cardiac lesions, placement of ventricular shunts, or spinal fusion procedures.7 Thus, little is known about the incidence of and risk factors for SSI after the most commonly performed pediatric surgical procedures. Broad changes in surgical practices have occurred over the
past decade. The number of “same day” or ambulatory surgery procedures (those without an overnight hospital stay) has risen to nearly 3 million per year and is expected to continue to rise.4 Many of these procedures are now performed in ambulatory surgical facilities (ASFs), freestanding facilities that are not loca- ted within an acute-care hospital. Because most ambulatory cases performed at either an ASF or a hospital-based facility are short in duration and are characterized as wound class 1 or 2, SSI rates have been presumed to be low. Data to support this assumption, however, are scarce. With the rising volume and complexity of ambulatory procedures, we must define the SSI risk to
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