156


Table 3. Risk Factors for Evidence of Possible Infection Associated With Surgery (N = 7,747)a Univariate


Characteristic Age


<12 mo 1–2 y 3–5 y


6–12 y 13–17 y Sex


Female Male


Race


White Black


Other/mixed


Insurance Private Public


Facility


Hospital-based ASF


No. of eligible procedures performed 1 2


≥3


5.1 4.1


4.5 5.3


10.5 Ref. 0.9 Ref.


0.9 1.7


(0.6–1.4) (0.9–3.2)


(0.7–1.1) .19


0.9 1.5


Ref.


(0.6–1.4) (0.8–2.9)


Note. OR, odds ratio; CI, confidence interval; ASF, ambulatory surgical facility; Ref., reference group; NA, not applicable. aUsing expanded definition, cases with strong or some evidence; 76 observations dropped in conditional analysis due to no outcomes in Strata; 53 children missing race were dropped from analyses including race.


SSI after ambulatory surgery may be >7,000 and that that the annual burden of possible infections after surgery may be >100,000. Thus, pediatric SSI represents a significant additional burden to the healthcare system as well as suffering and inconvenience to patients and their families. Because the volume of surgeries was high and the incidence of SSI was low, traditional surveillance methods cannot be efficiently deployed. Tools that can highlight patients, procedures, and facility characteristics at increased risk of infection would streamline the surveillance process. Alternatively, EHR functionality that flagged postoperative events (unscheduled encounters, antibiotic prescrip- tions, etc) could also help to focus surveillance resources. However, we observed poor agreement between parental report and EHR data indicating that surveillance relying on a single data source alone may not capture all possible infections. In ourrisk factoranalysis, younger age and nonblack race were


associated with possible postoperative infection. While not pre- viously reported for ambulatory pediatric surgery, young age has been reported as a risk factor for SSI after pediatric cardiac surgery.15


We hypothesize that higher risk may be due to behavioral and hygiene factors in this younger age group. For example, infants and toddlers may be apt to manipulate a wound and to also be diapered. Explanation of the association between patient race and infection is not clear,thoughitisunlikelytobebiological. Race maybeasso- ciated with factors (not captured in this study) that may affect tendency to seek or ability to access follow-up care or documenta- tion and/or provision of information from the parental interview. We believe this association warrants further investigation. Our study has several limitations. Ourstudy wasperformed in a


single healthcare network, so our findingsmay not be generalizable to all pediatric surgical settings. Ascertainment bias might have led to incomplete capture of all potential events. Similarly, our supplemental use of an expanded definition of postsurgical infection has not been validated. Children may seek follow-up care from a provider outside the CHOP network, such as an urgent care center, which would not be captured in the her; however, these events would hopefully be captured by the parental interview. The interview was conducted after


.36 .41 NA


5.2 2.6 5.1


4.8 4.7


Ref.


0.5 1.0


Ref. 1.0 (0.8–1.3)


(0.4–0.8) (0.8–1.3)


.93 .004


0.5 1.0


Ref.


(0.4–0.8) (0.8–1.3)


NA .005


4.8 4.7


Ref. 1.0 (0.8–1.3) .84 NA Raw Risk, %


6.7 5.0 4.2 4.0 5.0


OR Ref.


0.7 0.6 0.5 0.6


(0.5–1.1) (0.4–0.9) (0.3–0.7) (0.4–0.9)


(95% CI) P Value .014


0.7 0.6 0.5 0.6


OR Ref.


(0.5–1.1) (0.4–1.0) (0.4–0.8) (0.4–1.0)


Jeffrey S. Gerber et al


Multivariable (95% CI) P Value .021


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