Skip to main content Accessibility help
×
Home

Infections after pediatric ambulatory surgery: Incidence and risk factors

  • Jeffrey S. Gerber (a1) (a2) (a3), Rachael K. Ross (a1), Julia E. Szymczak (a3), Rui Xiao (a3), A. Russell Localio (a3), Robert W. Grundmeier (a2) (a4), Susan L Rettig (a5), Eva Teszner (a5), Doug A. Canning (a6) (a7) and Susan E. Coffin (a1) (a2)...

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.

Copyright

Corresponding author

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

Footnotes

Hide All

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

Footnotes

References

Hide All
1. Magill, SS, Wilson, LE, Thompson, DL, et al. Emerging Infections Program Hospital Prevalence Survey Team: reduction in the prevalence of healthcare-associated infections in US acute-care hospitals, 2015 vs 2011. Open Forum Infect Dis 2017;4 : S49.
2. The Society for Hospital Epidemiology of America, The Association for Practitioners in Infection Control, The Centers for Disease Control, and The Surgical Infection Society. Consensus paper on the surveillance of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:599–605.
3. Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Platt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9:196203.
4. Hall, MJ, Schwartzman, A, Zhang, J, Liu, X. Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010. Washington, DC: US Department of Health and Human Services; 2017.
5. Somme, S, Bronsert, M, Morrato, E, Ziegler, M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 2013;132:e1466e1472.
6. Hyder, JA, Hanson, KT, Storlie, CB, et al. Safety of overlapping surgery at a high-volume referral center. Ann Surg 2018;267:e91e92.
7. Schaffzin, JK, Harte, L, Marquette, S, et al. Surgical site infection reduction by the solutions for patient safety hospital engagement network. Pediatrics 2015;136:e1353e1360.
8. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783805.
9. Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) Patient Safety Component Key Terms. Atlanta, GA: CDC; 2010.
10. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.
11. Rinke, ML, Jan, D, Nassim, J, Choi, J, Choi, SJ. Surgical site infections following pediatric ambulatory surgery: an epidemiologic analysis. Infect Control Hosp Epidemiol 2016;37:931938.
12. Owens, PL, Barrett, ML, Raetzman, S, Maggard-Gibbons, M, Steiner, CA. Surgical site infections following ambulatory surgery procedures. JAMA 2014;311:709716.
13. Kulaylat, AN, Engbrecht, BW, Rocourt, DV, et al. Measuring surgical site infections in children: comparing clinical, electronic, and administrative data. J Am Coll Surg 2016;222:823830.
14. Dicks, KV, Lewis, SS, Durkin, MJ, et al. Surveying the surveillance: surgical site infections excluded by the January 2013 updated surveillance definitions. Infect Control Hosp Epidemiol 2014;35:570573.
15. Costello, JM, Graham, DA, Morrow, DF, et al. Risk factors for surgical site infection after cardiac surgery in children. Ann Thorac Surg 2010;89:18331841.
Type Description Title
WORD
Supplementary materials

Gerber et al. supplementary material
Tables S1 and S2

 Word (30 KB)
30 KB

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed