Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis

Abstract

OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective 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. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI 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. RESULTS In 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%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938.

Infections after pediatric ambulatory surgery: Incidence and risk factors

“…The rate of NHSN-defined SSI observed in our study was slightly less than previously reported. Using administrative billing codes, Rinke et al 11 reported a rate of 2.9 SSIs per 1,000 pediatric ambulatory procedures. Using a more liberal SSI definition, Owens et al 12 found a 30-day rate of “clinically significant SSI” of 4.84 SSIs per 1,000 surgical encounters among adults undergoing ambulatory surgery.…”

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

“…25 reported a single-center study with different methodology. 18 Notably, that study identified endocrine as incurring the greatest SSI incidence rather than the higher rates of integumentary, male genital, and musculoskeletal surgeries identified here. 18 The differences could be due to differing cohorts between multicenter versus single-center methodologies, and/or the more exhaustive search criteria used in this current study.…”

“…13 SSI following pediatric and adult ambulatory inguinal hernia surgery rates are between 0.5% to 4.8%, [14][15][16][17] with rates significantly higher in children and females. 17 In a single center study by this research group investigating SSI following pediatric ambulatory surgery with different case-finding methods, the SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries, or 10 times lower than SSI the rate following pediatric inpatient surgeries 18 but comparable with SSI rates following adult ambulatory surgery. The study's power precluded identification of risk factors.…”

Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

“…30 These modifications allowed us to study SSI following ambulatory surgery risk among patients undergoing procedures that are not included in the NSHN's list of inpatient operative procedures. 16 Data abstractors were trained to adjudicate HAI by a pediatric hospital epidemiologist on the research team (L.S. ), and they frequently shared adjudication questions for discussion and review.…”

“…Few studies have examined costs associated with pediatric HAI in ambulatory settings, despite many pediatric patients requiring long-term, ambulatory central lines, ambulatory urinary catheterization or outpatient surgery, and suggestions of high ambulatory pediatric HAI incidence. [10][11][12][13][14][15][16][17][18][19][20] A single-center study of ambulatory bloodstream infections (BSIs) and CLABSIs in pediatric oncology patients identified attributable charges (not costs) of $36,611. 21 In pediatric and adult patients with SSIs following hernia repair and anterior cruciate ligament reconstruction, 2 surgeries commonly performed as ambulatory, costs ranged from $3,028 to $16,489 and from $3,735 to $19,356 (2014 USD), respectively.…”