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

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.

Does a Presurgical Antisepsis Protocol Decrease Surgical Site Infections in Young Children?

“…Several studies in ambulatory settings involving procedures similar to those in our sample reported SSIs. 2,19,20 At our facility, SSI rates are low, at 1.18 infections per 100 patients aged 2 through 11 years. In an ACS National Surgical Quality Improvement Program Pediatric study, the national SSI rate in children was reported to be 1.8%.…”

“…2 The highest weighted incidence of SSI after surgery included integumentary surgeries at a rate of 3.24 per 1,000 surgeries, and the authors found that clean-contaminated or contaminated wound class increased the odds of an infection. 2 Because many studies aggregate ages, with few mentioning a lower age limit, it is not possible to determine age-specific SSI outcomes and, specifically, SSI rates in pediatric patients. No literature was found that specifically examined SSIs in this age group (2 through 11 years); therefore, this study fills a gap by including only the 2-through 11-year-old age group across all specialties and surgery types.…”

“…20 In a five-year multicenter study, chart reviews were queried for 13,795 pediatric patients. 2 The highest weighted incidence of SSI after surgery included integumentary surgeries at a rate of 3.24 per 1,000 surgeries, and the authors found that clean-contaminated or contaminated wound class increased the odds of an infection. 2 Because many studies aggregate ages, with few mentioning a lower age limit, it is not possible to determine age-specific SSI outcomes and, specifically, SSI rates in pediatric patients.…”

“…Specific surgery‐type studies for inguinal hernia surgical repair for adult and pediatric patients show varying SSI rates between 0.45% to 4.8% 20 . In a five‐year multicenter study, chart reviews were queried for 13,795 pediatric patients 2 . The highest weighted incidence of SSI after surgery included integumentary surgeries at a rate of 3.24 per 1,000 surgeries, and the authors found that clean‐contaminated or contaminated wound class increased the odds of an infection 2 …”

Risk factors of wound infection after lung transplantation: a narrative review

“…Study has shown that the duration of chest drainage tube indwelling after lung transplantation is also closely related to postoperative incision infection (41). The duration of chest drainage tube placement was significantly longer in patients with infexction than those without (18.0 vs. 14.0 hours, P=0.009) (42). As a particular type of nosocomial infection, drainage tube-related infection can increase the incidence of incision site infection in patients after general surgery and thoracic surgery.…”