Rates and burden of surgical site infections associated with pediatric colorectal surgery: insight from the National Surgery Quality Improvement Program

Feng, Christina; Sidhwa, Feroze; Cameron, Danielle B.; Glass, Charity C.; Rangel, Shawn J.

doi:10.1016/j.jpedsurg.2016.02.063

Cited by 37 publications

(26 citation statements)

References 28 publications

(33 reference statements)

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“…[3] In particular, pediatric colorectal procedures account for a disparate burden of surgical site infection (SSI) relative to other surgical procedures in children. [4] Likewise, at our institution, pediatric ACS NSQIP data mirrors this finding, where pediatric colorectal surgery patients encompass the highest degree of SSI compared to other procedural groups, experiencing surgical infection rates of 5-18% (Unpublished data, Jelin, 2016; Boss, 2016). The high infection rate in the setting of relatively common pediatric colorectal procedures make this subspecialty an attractive group for early ERAS pathway trials in children.…”

Section: Introductionsupporting

confidence: 52%

Preparing enhanced recovery after surgery for implementation in pediatric populations

Leeds

Boss

George

et al. 2016

Journal of Pediatric Surgery

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Standardization in perioperative care has led to major improvements in surgical outcomes during the last two decades. Enhanced Recovery After Surgery (ERAS) programs are one example of a clinical pathway impacting both surgical outcomes and efficiency of care, but these programs have not yet been widely adapted for surgery in children. In adults, ERAS pathways have been shown to reduce length of stay, reduce complication rates, and improve patient satisfaction. These pathways improve outcomes through standardization of existing evidence-based best practices. Currently, the direct evidence for adapting ERAS pathways to pediatric surgery patients is limited. Challenges for implementation of ERAS programs for children include lack of direct translatability of adult evidence as well as varying levels acceptability of ERAS principles among pediatric providers and patients’ families. We describe a proposed ERAS program for pediatric colorectal surgery patients in an era of limited direct evidence and discuss what further issues need to be addressed for broader implementation of pediatric ERAS pathways.

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Section: Introductionsupporting

confidence: 52%

Preparing enhanced recovery after surgery for implementation in pediatric populations

Leeds

Boss

George

et al. 2016

Journal of Pediatric Surgery

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“…98 The SSI rates of all types of colorectal surgery were 5.9% (ISSIs: 3.2%; OSIs: 2.7%) with the uppermost being total abdominal colectomy (11.4%) trailed by partial colectomy (8.3%) and colostomy closure (5.0%). 98 Inflammatory bowel diseases caused the topmost health problems in a comparison of all colorectal diagnosed diseases (24.9%; ISSIs: 22%; OSIs: 28.6%). Hirschsprung's disease (14.2%; ISSIs: 15.4%; OSIs: 12.8%) and anorectal malformations (12.4%; ISSIs: 17.6%; OSIs: 6.4%) were the next major group in colorectal diseases.…”

mentioning

confidence: 95%

“…88 The SSI rates did not differ among the suture types overall in gastric surgery or in appendectomy. 98 A US study of pediatric patients found that while this was only 2.5% of the caseload, colorectal surgery contributed to 7.1% of the SSIs. 98 The SSI rates of all types of colorectal surgery were 5.9% (ISSIs: 3.2%; OSIs: 2.7%) with the uppermost being total abdominal colectomy (11.4%) trailed by partial colectomy (8.3%) and colostomy closure (5.0%).…”

mentioning

confidence: 99%

“…98 A US study of pediatric patients found that while this was only 2.5% of the caseload, colorectal surgery contributed to 7.1% of the SSIs. 98 The SSI rates of all types of colorectal surgery were 5.9% (ISSIs: 3.2%; OSIs: 2.7%) with the uppermost being total abdominal colectomy (11.4%) trailed by partial colectomy (8.3%) and colostomy closure (5.0%). 98 Inflammatory bowel diseases caused the topmost health problems in a comparison of all colorectal diagnosed diseases (24.9%; ISSIs: 22%; OSIs: 28.6%).…”

mentioning

confidence: 99%

“…Hirschsprung's disease (14.2%; ISSIs: 15.4%; OSIs: 12.8%) and anorectal malformations (12.4%; ISSIs: 17.6%; OSIs: 6.4%) were the next major group in colorectal diseases. 98 Finally, a study utilizing univariate analysis defined 13 statistically significantly variables related to SSIs. Those were patients aged over 60 years, lower functional status, diabetes mellitus, congestive heart failure, immunocompromising disease, anticancer medications, immunosuppressive agents, impaired immune system, open cholecystectomy, laparotomy, an American Society of Anesthesiologists score above 2, drain insertion, and dirty wound.…”

mentioning

confidence: 99%

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Health care-associated infections – an overview

Haque¹,

Sartelli²,

McKimm³

et al. 2018

IDR

909

610

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Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. Multiple studies indicate that the common types of adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications. The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one in 17) die due to these. Several studies suggest that simple infection-control procedures such as cleaning hands with an alcohol-based hand rub can help prevent HCAIs and save lives, reduce morbidity, and minimize health care costs. Routine educational interventions for health care professionals can help change their hand-washing practices to prevent the spread of infection. In support of this, the WHO has produced guidelines to promote hand-washing practices among member countries.

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Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery

Nayak

Allori

et al. 2022

JAMA Surg

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ImportanceUse of postoperative antimicrobial prophylaxis is common in pediatric surgery despite consensus guidelines recommending discontinuation following incision closure. The association between postoperative prophylaxis use and surgical site infection (SSI) in children undergoing surgical procedures remains poorly characterized.ObjectiveTo evaluate whether use of postoperative surgical prophylaxis is correlated with SSI rates in children undergoing nonemergent surgery.Design, Setting, and ParticipantsThis is a multicenter cohort study using 30-day postoperative SSI data from the American College of Surgeons’ Pediatric National Surgical Quality Improvement Program (ACS NSQIP-Pediatric) augmented with antibiotic-use data obtained through supplemental medical record review from June 2019 to June 2021. This study took place at 93 hospitals participating in the ACS NSQIP-Pediatric Surgical Antibiotic Prophylaxis Stewardship Collaborative. Participants were children (&lt;18 years of age) undergoing nonemergent surgical procedures. Exclusion criteria included antibiotic allergies, conditions associated with impaired immune function, and preexisting infections requiring intravenous antibiotics at time of surgery.ExposuresContinuation of antimicrobial prophylaxis beyond time of incision closure.Main Outcomes and MeasuresThirty-day postoperative rate of incisional or organ space SSI. Hierarchical regression was used to estimate hospital-level odds ratios (ORs) for SSI rates and postoperative prophylaxis use. SSI measures were adjusted for differences in procedure mix, patient characteristics, and comorbidity profiles, while use measures were adjusted for clinically related procedure groups. Pearson correlations were used to examine the associations between hospital-level postoperative prophylaxis use and SSI measures.ResultsForty thousand six hundred eleven patients (47.3% female; median age, 7 years) were included, of which 41.6% received postoperative prophylaxis (hospital range, 0%-71.2%). Odds ratios (ORs) for postoperative prophylaxis use ranged 190-fold across hospitals (OR, 0.10-19.30) and ORs for SSI rates ranged 4-fold (OR, 0.55-1.90). No correlation was found between use of postoperative prophylaxis and SSI rates overall (r = 0.13; P = .20), and when stratified by SSI type (incisional SSI, r = 0.08; P = .43 and organ space SSI, r = 0.13; P = .23), and surgical specialty (general surgery, r = 0.02; P = .83; urology, r = 0.05; P = .64; plastic surgery, r = 0.11; P = .35; otolaryngology, r = −0.13; P = .25; orthopedic surgery, r = 0.05; P = .61; and neurosurgery, r = 0.02; P = .85).Conclusions and RelevanceUse of postoperative surgical antimicrobial prophylaxis was not correlated with SSI rates at the hospital level after adjusting for differences in procedure mix and patient characteristics.

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Rates and burden of surgical site infections associated with pediatric colorectal surgery: insight from the National Surgery Quality Improvement Program

Cited by 37 publications

References 28 publications

Preparing enhanced recovery after surgery for implementation in pediatric populations

Preparing enhanced recovery after surgery for implementation in pediatric populations

Health care-associated infections – an overview

Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery

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Rates and burden of surgical site infections associated with pediatric colorectal surgery: insight from the National Surgery Quality Improvement Program

Cited by 37 publications

References 28 publications

Preparing enhanced recovery after surgery for implementation in pediatric populations

Preparing enhanced recovery after surgery for implementation in pediatric populations

Health care-associated infections &ndash; an overview

Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery

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Product

Resources

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Health care-associated infections – an overview