Pediatric surgical site infection (SSI) following ambulatory surgery: Incidence, risk factors and patient outcomes

2021 ◽  
pp. 1-7
Author(s):  
Michael L. Rinke ◽  
David G. Bundy ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
Barbara Rabin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ambulatory Surgery ◽  
Operative Procedure ◽  
Epidemiologic Study ◽  
Surgical Site Infections ◽  
Incidence Rates ◽  
Medical Centers ◽  
Incidence Risk ◽  
Contaminated Wound ◽  
Clean Contaminated

Abstract Background: Inpatient surgical site infections (SSIs) cause morbidity in children. The SSI rate among pediatric ambulatory surgery patients is less clear. To fill this gap, we conducted a multiple-institution, retrospective epidemiologic study to identify incidence, risk factors, and outcomes. Methods: We identified patients aged <22 years with ambulatory visits between October 2010 and September 2015 via electronic queries at 3 medical centers. We performed sample chart reviews to confirm ambulatory surgery and adjudicate SSIs. Weighted Poisson incidence rates were calculated. Separately, we used case–control methodology using multivariate backward logistical regression to assess risk-factor association with SSI. Results: In total, 65,056 patients were identified by queries, and we performed complete chart reviews for 13,795 patients; we identified 45 SSIs following ambulatory surgery. The weighted SSI incidence following pediatric ambulatory surgery was 2.00 SSI per 1,000 ambulatory surgeries (95% confidence interval [CI], 1.37–3.00). Integumentary surgeries had the highest weighted SSI incidence, 3.24 per 1,000 ambulatory surgeries (95% CI, 0.32–12). The following variables carried significantly increased odds of infection: clean contaminated or contaminated wound class compared to clean (odds ratio [OR], 9.8; 95% CI, 2.0–48), other insurance type compared to private (OR, 4.0; 95% CI, 1.6–9.8), and surgery on weekend day compared to weekday (OR, 30; 95% CI, 2.9–315). Of the 45 instances of SSI following pediatric ambulatory surgery, 40% of patients were admitted to the hospital and 36% required a new operative procedure or bedside incision and drainage. Conclusions: Our findings suggest that morbidity is associated with SSI following ambulatory surgery in children, and we also identified possible targets for intervention.

scholarly journals Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5865
Author(s):  
Salma Younes ◽  
Muthanna Samara ◽  
Rana Al-Jurf ◽  
Gheyath Nasrallah ◽  
Sawsan Al-Obaidly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Population Based ◽  
Incidence Rates ◽  
Large For Gestational Age ◽  
Mortality And Morbidity ◽  
Early Term ◽  
Incidence Risk

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction

2016 ◽  
Vol 126 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Neerav Goyal ◽  
Bharat B. Yarlagadda ◽  
Daniel G. Deschler ◽  
Kevin S. Emerick ◽  
Derrick T. Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head And Neck ◽  
Free Flap ◽  
Operating Time ◽  
Surgical Site Infections ◽  
Free Flaps ◽  
Neck Surgery ◽  
Pedicled Flap ◽  
American Society ◽  
Clean Contaminated

Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted. A free flap cohort was reviewed for comparison. Results: Two hundred and eight pedicled reconstructions were performed for cancer (83%), osteoradionecrosis (7%), and other reasons (10%). Most (72%) cases were clean-contaminated and American Society of Anesthesiologists classification 3 or higher (73%); 63% of patients had prior radiation. The SSIs occurred in 9.1% and were associated with a longer length of stay ( P = .004) but no particular risk factors. Seventeen patients developed a fistula (11 without SSI). The SSI rates were not significantly different between pedicled and free flaps, but pedicled flap patients were older, more likely to have had prior surgery and/or radiation, and be methicillin-resistant Staphylococcus aureus positive. In the combined population, multivariate analysis demonstrated clean-contaminated wound classification ( P = .03), longer operating time ( P = .03), and clindamycin prophylaxis ( P = .009) as SSI risk factors. Conclusions: The SSI rate following pedicled flap surgeries was low and similar to free flap surgeries despite a significantly different population. No specific risk factors were associated with developing a pedicled flap SSI.

Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis

2016 ◽  
Vol 37 (8) ◽  
pp. 931-938 ◽  
Author(s):  
Michael L. Rinke ◽  
Dominique Jan ◽  
Janelle Nassim ◽  
Jaeun Choi ◽  
Steven J. Choi
Keyword(s):  
Risk Factors ◽  
Sensitivity And Specificity ◽  
Random Sampling ◽  
Ambulatory Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Systematic Random Sampling ◽  
National Healthcare ◽  
National Healthcare Safety Network

OBJECTIVETo identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes.DESIGNRetrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition.SETTINGUrban pediatric tertiary care center April 1, 2009-March 31, 2014.METHODSSSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case–rest of cohort, and case-control, designs.RESULTSIn 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2–6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (P<.0001), and respiratory (P=.01) surgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%–91.33%) and specificity was 99.94% (99.89%–99.97%).CONCLUSIONSSSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children.Infect Control Hosp Epidemiol 2016;37:931–938

scholarly journals Incidence, risk factors and etiological agents in surgical site infections in a developing country

2011 ◽  
Vol 5 (S6) ◽  
Author(s):  
E Alp ◽  
F Elmali ◽  
S Ersoy ◽  
C Kucuk ◽  
B Tucer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Developing Country ◽  
Surgical Site Infections ◽  
Incidence Risk ◽  
Etiological Agents

scholarly journals Risk of surgical site infection in patients undergoing orthopedic surgery

2011 ◽  
Vol 19 (6) ◽  
pp. 1362-1368 ◽  
Author(s):  
Flávia Falci Ercole ◽  
Lúcia Maciel Castro Franco ◽  
Tamara Gonçalves Rezende Macieira ◽  
Luísa Cristina Crespo Wenceslau ◽  
Helena Isabel Nascimento de Resende ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Descriptive Analysis ◽  
Surgical Site Infections ◽  
Incidence Rates ◽  
Site Infection ◽  
Chi Square ◽  
Historical Cohort ◽  
Surgical Site Infection Incidence ◽  
Chi Square Test

This study aimed to identify risk factors associated with surgical site infections in orthopedic surgical patients at a public hospital in Minas Gerais, Brazil, between 2005 and 2007. A historical cohort of 3,543 patients submitted to orthopedic surgical procedures. A descriptive analysis was conducted and surgical site infection incidence rates were estimated. To verify the association between infection and risk factors, the Chi-square Test was used. The strength of association of the event with the independent variables was estimated using Relative Risk, with a 95% confidence interval and p<0.05. The incidence of surgical site infection was 1.8%. Potential surgical wound contamination, clinical conditions, time and type of surgical procedure were statistically associated with infection. Identifying the association between surgical site infection and these risk factors is important and contributes to nurses’ clinical practice.

scholarly journals Prevalence of surgical site infections and their sensitivity patterns in elective abdominal surgeries in King George Hospital, Visakhapatnam

2020 ◽  
Vol 7 (7) ◽  
pp. 2247
Author(s):  
Pratha Anantha Ramani ◽  
Simhadri Uday Kiran ◽  
Murali Manohar Deevi ◽  
Ginni Vijay Sainath Reddy ◽  
Ginjupalli Saichand ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Surgical Site Infections ◽  
Wound Dressings ◽  
Site Infection ◽  
Antibiotic Resistant ◽  
Clean Contaminated ◽  
King George Hospital ◽  
A Prospective Study ◽  
Prolonged Hospital

Background: Surgical site infections are one of the most common complications in the postoperative period leading to increased morbidity, prolonged hospital stay and reduced quality of life. The present study aims to identify the incidence of surgical site infection (SSI), risk factors, causative organisms, and their sensitivity patterns in patients who have undergone elective abdominal surgeries.Methods: A prospective study containing 200 patients who have undergone elective abdominal surgeries from May 2018 to January 2020 were evaluated. A thorough history was taken in all the patients. A detailed clinical examination and routine investigations were done. Parameters such as body mass index (BMI), diabetic status, type of surgery, wound grading, culture, and sensitivity patterns were considered. The patients underwent treatment based on their investigatory reports.Results: In the present study, 54 patients developed surgical site infection, and among them, 22 are diabetics. Only ten patients with normal BMI developed SSI, whereas the other 44 patients who developed SSI had abnormal BMI. The incidence of SSI was higher in clean-contaminated surgeries comprising up to 89% of cases. Staphylococcus aureus was the most commonly isolated organism, and cefoperazone plus sulbactam was the most sensitive on antibiogram.Conclusions: The surgical site infections are on rising trend due to the emergence of antibiotic-resistant microorganisms. Treatment of the underlying risk factors, regular wound dressings, and antibiotics, according to sensitivity patterns, are the mainstay. 

scholarly journals Surveillance of surgical site infections to determine incidence, risk factors and microbiologic spectrum following obstetric and gynaecological surgeries

2018 ◽  
Vol 7 (10) ◽  
pp. 4029
Author(s):  
Seetha Panicker ◽  
T. V. Chitra
Keyword(s):  
Risk Factors ◽  
Operating Time ◽  
Surgical Site Infections ◽  
Multidrug Resistant ◽  
E Coli ◽  
Incidence Risk ◽  
Resistant Strains ◽  
Prolonged Hospital ◽  
Drug Resistant Strains ◽  
Hospital Acquired

Background: Surgical site infections (SSI) are one of the major health problems throughout the world with an incidence of 3%-16%. Hospital acquired surgical site infection is further complicated by the emergence of multi drug resistant strains. SSI surveillance is an established monitoring tool and has been shown to reduce infection rates. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stay, need for readmission, high end antibiotic treatment and re-surgery. This study was undertaken to determine the incidence, risk factors, and microbiological spectrum of surgical site infections and to identify the multidrug resistant strains.  Analysis of the effectiveness of the existing surveillance methods was also done.Methods: This retrospective study was done for a period of 1-year form Jan 2016 to Dec 2016. All patients with infection following caesarean section and abdominal and vaginal hysterectomy were included. Laparoscopic surgery and patients with preexisting infection were excluded.Results: Incidence of SSI in present study is 5.27%. The major risk factors identified were obesity, diabetes and prolonged operating time.  The commonest infective organism was Klebsiella Pneumoniae in 37% of which 19% were ESBL producing and 3.8% were carbapenemase producing. E. coli was identified in 20% of isolates. The incidence of ESBL in both isolates was higher.Conclusions: Regular audit of SSIs is a very effective tool to analyse risk factors, identify causes and plan strategies to prevent infection.

scholarly journals A Socio-Technical, Probabilistic Risk Assessment Model for Surgical Site Infections in Ambulatory Surgery Centers

2014 ◽  
Vol 35 (S3) ◽  
pp. S133-S141 ◽  
Author(s):  
Ebru K. Bish ◽  
Hadi El-Amine ◽  
Laura A. Steighner ◽  
Anthony D. Slonim
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Ambulatory Surgery ◽  
Surgical Site Infections ◽  
Probabilistic Risk Assessment ◽  
Assessment Model ◽  
Antibiotic Administration ◽  
Ambulatory Care Setting ◽  
Skin Preparation ◽  
Probabilistic Risk

Background.To understand how structural and process elements may affect the risk for surgical site infections (SSIs) in the ambulatory surgery center (ASC) environment, the researchers employed a tool known as socio-technical probabilistic risk assessment (ST-PRA). ST-PRA is particularly helpful for estimating risks in outcomes that are very rare, such as the risk of SSI in ASCs.Objective.Study objectives were to (1) identify the risk factors associated with SSIs resulting from procedures performed at ASCs and (2) design an intervention to mitigate the likelihood of SSIs for the most common risk factors that were identified by the ST-PRA for a particular surgical procedure.Methods.ST-PRA was used to study the SSI risk in the ASC setting. Both quantitative and qualitative data sources were utilized, and sensitivity analysis was performed to ensure the robustness of the results.Results.The event entitled “fail to protect the patient effectively” accounted for 51.9% of SSIs in the ambulatory care setting. Critical components of this event included several failure risk points related to skin preparation, antibiotic administration, staff training, proper response to glove punctures during surgery, and adherence to surgical preparation rules related to the wearing of jewelry, watches, and artificial nails. Assuming a 75% reduction in noncompliance on any combination of 2 of these 5 components, the risk for an SSI decreased from 0.0044 to between 0.0027 and 0.0035.Conclusion.An intervention that targeted the 5 major components of the major risk point was proposed, and its implications were discussed.

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