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Contribution of Prior, Multiple-, and Repetitive Surgeries to the Risk of Surgical Site Infections in the Netherlands

Published online by Cambridge University Press:  18 September 2017

Janneke D. M. Verberk ,
Anouk P. Meijs ,
Margreet C. Vos ,
Liesbeth M. A. Schreurs ,
Suzanne E. Geerlings ,
Sabine C. de Greeff  and
Mayke B. G. Koek
Janneke D. M. Verberk*
Affiliation:
Department Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
Anouk P. Meijs
Affiliation:
Department Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
Margreet C. Vos
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
Liesbeth M. A. Schreurs
Affiliation:
Hospital Group Twente (ZGT), Department of Surgery, Almelo, the Netherlands
Suzanne E. Geerlings
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
Sabine C. de Greeff
Affiliation:
Department Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
Mayke B. G. Koek*
Affiliation:
Department Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
*
Address correspondence to Janneke D. M. Verberk, MSc, Room U3.46, Postbus 1 (postbak 75), 3720 BA Bilthoven, the Netherlands, (janneke.verberk@rivm.nl) or Mayke BG Koek, MD, Phd, MSc, Room U2.30, Postbus 1 (postbak 75), 3720 BA Bilthoven, the Netherlands (mayke.koek@rivm.nl).
Address correspondence to Janneke D. M. Verberk, MSc, Room U3.46, Postbus 1 (postbak 75), 3720 BA Bilthoven, the Netherlands, (janneke.verberk@rivm.nl) or Mayke BG Koek, MD, Phd, MSc, Room U2.30, Postbus 1 (postbak 75), 3720 BA Bilthoven, the Netherlands (mayke.koek@rivm.nl).
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Abstract

OBJECTIVE

Surveillance is an important strategy to reduce the incidence of surgical site infections (SSIs). We investigated whether prior, multiple-, or repetitive surgeries are risk factors for SSI and whether they should be preserved in the protocol of the Dutch national SSI surveillance network.

METHODS

Dutch national SSI surveillance data 2012–2015 were selected, including 34 commonly performed procedures from 8 major surgical specialties. Definitions of SSIs followed international standardized criteria. We used multivariable multilevel logistic regression techniques to evaluate whether prior, multiple-, or repetitive procedure(s) are risk factors for SSIs. We considered surgeries clustered within partnerships of medical specialists and within hospitals (random effects) and different baseline risks between surgical specialties (fixed effects). Several patient and surgical characteristics were considered possible confounders and were included where necessary. We performed analyses for superficial and deep SSIs combined as well as separately.

RESULTS

In total, 115,943 surgeries were reported by 85 hospitals; among them, 2,960 (2.6%) resulted in SSIs (49.3% deep SSIs). The odds ratio (OR) for having prior surgery was 0.94 (95% confidence interval [CI], 0.74–1.20); the OR for repetitive surgery was 2.39 (95% CI, 2.06–2.77); and the OR for multiple surgeries was1.27 (95% CI, 1.07–1.51). The latter effect was mainly caused by prolonged duration of surgery.

CONCLUSIONS

Multiple- and repetitive surgeries significantly increased the risk of an SSI, whereas prior surgery did not. Therefore, prior surgery is not an essential data item to include in the national SSI surveillance network. The increased risk of SSIs for multiple surgeries was mainly caused by prolonged duration of surgery, therefore, it may be sufficient to report only duration of surgery to the surveillance network, instead of both (the variables duration of surgery and multiple surgeries).

Infect Control Hosp Epidemiol 2017;38:1298–1305

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 11 , November 2017 , pp. 1298 - 1305
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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