Infection Rate Low With Ambulatory Surgeries, Could Be Lower

Marcia Frellick

February 18, 2014

Rates for postsurgical visits for clinically significant surgical site infections among patients who have undergone ambulatory surgery were low but "may still represent a substantial number of adverse outcomes in aggregate," the authors of a new study write.

Surgical site infections account for 20% to 31% of healthcare-associated infections in hospitalized patients. They come with a mortality rate of 3%, hospital stays lengthened by 7 to 10 days, and costs of $20,000 to $27,600 per admission. However, little has been known about infections after ambulatory surgery, write Pamela L. Owens, PhD, from the Agency for Healthcare Research and Quality, Rockville, Maryland, and colleagues in an article published online February 18 in JAMA.

Therefore, the authors examined the incidence of clinically significant surgical site infections after low- to moderate-risk ambulatory surgery in 284,098 patients at low risk for surgical complications.

They used the 2010 Healthcare Cost and Utilization Project State Ambulatory Surgery and State Inpatient Databases for 8 states (California, Florida, Georgia. Hawaii, Missouri, Nebraska, New York, and Tennessee), representing one third of the US population.

They analyzed ambulatory general surgery and orthopedic, neurosurgical, gynecologic, and urologic operations in adult patients. They defined low risk as the patient not being seen in the last 30 days in acute care, having a length of stay of less than 2 days, having no other surgery on the same day, and being discharged home and having no infection on the same day.

The researchers found that the rate of postsurgical acute care visits within 14 days for clinically significant surgical site infections was 3.09 (95% confidence interval [CI], 2.89 - 3.30) per 1000 ambulatory procedures. The rate increased to 4.84 (95% CI, 4.59 - 5.10) when the researchers extended the time frame to 30 days.

Despite the low rate, the authors note that the absolute incidence of surgical site infections is significant, given the large and growing numbers of ambulatory surgeries in the United States: 18.7 million in 2010, or 63.6% of all operations. Most (63.7%; 3.09 per 1000 ambulatory surgical procedures) of these infections occurred within 2 weeks after surgery, and 93.2% (95 CI, 91.3% - 94.7%) resulted in hospital admission.

Reporting at both 14 days and 30 days is relevant because follow-up visits often are scheduled beyond the 2-week time frame. The authors say that, for example, studies have shown that routine follow-up was 3 weeks for inguinal hernia, laparoscopic cholecystectomy, and anorectal surgical procedures and from 2 to 4 weeks for adenotonsillectomy.

"Our findings suggest that earlier access to a clinician or member of the surgical team (eg, telephone check-in prior to 2 weeks) may help identify and treat these infections early and reduce overall morbidity," they write.

This study was funded by the Agency for Healthcare Research and Quality under a contract to Truven Health Analytics to develop and support the Healthcare Cost and Utilization Project. The authors have disclosed no relevant financial relationships.

JAMA. 2014;311:709-716. Abstract

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