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Infections after pediatric ambulatory surgery: Incidence and risk factors

Published online by Cambridge University Press:  30 January 2019

Jeffrey S. Gerber ,
Rachael K. Ross ,
Julia E. Szymczak ,
Rui Xiao ,
A. Russell Localio ,
Robert W. Grundmeier ,
Susan L Rettig ,
Eva Teszner ,
Doug A. Canning  and
Susan E. Coffin
Jeffrey S. Gerber*
Affiliation:
Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Rachael K. Ross
Affiliation:
Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Julia E. Szymczak
Affiliation:
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Rui Xiao
Affiliation:
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
A. Russell Localio
Affiliation:
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Robert W. Grundmeier
Affiliation:
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Susan L Rettig
Affiliation:
Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Eva Teszner
Affiliation:
Department of Infection Prevention and Control, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Doug A. Canning
Affiliation:
Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Jeffrey S. Gerber MD, PhD, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 10364, Philadelphia, PA 9146-2305. E-mail: gerberj@chop.edu
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Abstract

Objective

To describe the epidemiology of surgical site infections (SSIs) after pediatric ambulatory surgery.

Design

Observational cohort study with 60 days follow-up after surgery.

Setting

The study took place in 3 ambulatory surgical facilities (ASFs) and 1 hospital-based facility in a single pediatric healthcare network.

Participants

Children <18 years undergoing ambulatory surgery were included in the study. Of 19,777 eligible surgical encounters, 8,502 patients were enrolled.

Methods

Data were collected through parental interviews and from chart reviews. We assessed 2 outcomes: (1) National Healthcare Safety Network (NHSN)–defined SSI and (2) evidence of possible infection using a definition developed for this study.

Results

We identified 21 NSHN SSIs for a rate of 2.5 SSIs per 1,000 surgical encounters: 2.9 per 1,000 at the hospital-based facility and 1.6 per 1,000 at the ASFs. After restricting the search to procedures completed at both facilities and adjustment for patient demographics, there was no difference in the risk of NHSN SSI between the 2 types of facilities (odds ratio, 0.7; 95% confidence interval, 0.2–2.3). Within 60 days after surgery, 404 surgical patients had some or strong evidence of possible infection obtained from parental interview and/or chart review (rate, 48 SSIs per 1,000 surgical encounters). Of 306 cases identified through parental interviews, 176 cases (57%) did not have chart documentation. In our multivariable analysis, older age and black race were associated with a reduced risk of possible infection.

Conclusions

The rate of NHSN-defined SSI after pediatric ambulatory surgery was low, although a substantial additional burden of infectious morbidity related to surgery might not have been captured by standard surveillance strategies and definitions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 150 - 157
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Gerber JS, et al. (2019). Infections after pediatric ambulatory surgery: Incidence and risk factors. Infection Control & Hospital Epidemiology 2019, 40, 150–157. doi: 10.1017/ice.2018.211

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