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

Published online by Cambridge University Press:  11 August 2021

Michael L. Rinke Open the ORCID record for Michael L. Rinke [Opens in a new window] ,
David G. Bundy ,
Moonseong Heo ,
Lisa Saiman ,
Barbara Rabin ,
Philip Zachariah ,
Rebecca E. Rosenberg ,
Patricia DeLaMora ,
Parsa Mirhaji  and
Michael Drasher
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Michael L. Rinke*
Affiliation:
Children’s Hospital at Montefiore, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
David G. Bundy
Affiliation:
Medical University of South Carolina, Charleston, South Carolina
Moonseong Heo
Affiliation:
Clemson University, Clemson, South Carolina
Lisa Saiman
Affiliation:
Columbia University Irving Medical Center, New York, New York
Barbara Rabin
Affiliation:
Icahn School of Medicine at Mount Sinai, New York, New York
Philip Zachariah
Affiliation:
Columbia University Irving Medical Center, New York, New York
Rebecca E. Rosenberg
Affiliation:
New York University School of Medicine, New York, New York
Patricia DeLaMora
Affiliation:
Weill Cornell Medical College, New York, New York
Parsa Mirhaji
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
Michael Drasher
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan
Elizabeth Klein
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
Oghale Obaro-Best
Affiliation:
State University of New York Upstate Medical University, Syracuse, New York
William J.H. Ford
Affiliation:
Weill Cornell Medical College, New York, New York
Diana Zarowin
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
Alexandre Peshansky
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
Suzette O. Oyeku
Affiliation:
Children’s Hospital at Montefiore, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
*
Author for correspondence: Michael L. Rinke, E-mail: mrinke@montefiore.org
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Abstract

Background:

Inpatient surgical site infections (SSIs) cause morbidity in children. The SSI rate among pediatric ambulatory surgery patients is less clear. To fill this gap, we conducted a multiple-institution, retrospective epidemiologic study to identify incidence, risk factors, and outcomes.

Methods:

We identified patients aged <22 years with ambulatory visits between October 2010 and September 2015 via electronic queries at 3 medical centers. We performed sample chart reviews to confirm ambulatory surgery and adjudicate SSIs. Weighted Poisson incidence rates were calculated. Separately, we used case–control methodology using multivariate backward logistical regression to assess risk-factor association with SSI.

Results:

In total, 65,056 patients were identified by queries, and we performed complete chart reviews for 13,795 patients; we identified 45 SSIs following ambulatory surgery. The weighted SSI incidence following pediatric ambulatory surgery was 2.00 SSI per 1,000 ambulatory surgeries (95% confidence interval [CI], 1.37–3.00). Integumentary surgeries had the highest weighted SSI incidence, 3.24 per 1,000 ambulatory surgeries (95% CI, 0.32–12). The following variables carried significantly increased odds of infection: clean contaminated or contaminated wound class compared to clean (odds ratio [OR], 9.8; 95% CI, 2.0–48), other insurance type compared to private (OR, 4.0; 95% CI, 1.6–9.8), and surgery on weekend day compared to weekday (OR, 30; 95% CI, 2.9–315). Of the 45 instances of SSI following pediatric ambulatory surgery, 40% of patients were admitted to the hospital and 36% required a new operative procedure or bedside incision and drainage.

Conclusions:

Our findings suggest that morbidity is associated with SSI following ambulatory surgery in children, and we also identified possible targets for intervention.

Keywords

SSIpediatricambulatory
Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 8 , August 2022 , pp. 1036 - 1042
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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