Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Abstract

Introduction: Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance. Methods: We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identifi ed during the hospital stay and after discharge. Results: Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions: Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance.

Incidence and risk factors for surgical site infection in general surgeries

“…The variation in incidence rates observed between the literature and the data from this study may be related to the presence of different epidemiological surveillance systems at national level 2 , 14 - 15 , Post-discharge Surveillance 8 , 16 (PDS) and possible occurrence of underreporting of SSI.…”

“…However, it was lower than in studies carried out in data reported from India and Turkey, which presented an SSI incidence of 5.0% 16 ) and 4.1% 17 , respectively. Two Brazilian studies involving SSI in general surgeries had higher rates than the identified incidence and compared to international researches, ranging from 6.4% 8 to 11.0% 3 .…”

“…Those surgeries as clean-contaminated, contaminated and dirty/infected showed an increase of 54%, 167% and 105%, respectively, in the chance of developing SSI when compared to clean wounds. The wound class is reported in several nationals and internationals literatures as a risk factor associated with SSI 2 , 6 , 13 - 17 , although it is not present in a research involving general surgeries in Brazil 8 .…”

“…In Brazil, data on the incidence of SSI in general and specific surgeries vary from 1.4% to 38.8% 3 - 9 . It is important to note that, of these studies, only two refer to data from general surgeries 3 , 8 .…”

Surgical site infections in women and their association with clinical conditions

“…In this study, the incidence of post-discharge SSIs in the women surveyed was 5.8%. At the university hospital of the College of Medicine of Botucatu, 62.2% of gynecological SSIs began after hospital discharge 5 . Thus, post-discharge monitoring after surgical procedures contributes to increased reporting of SSI incidence.…”