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Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis

Published online by Cambridge University Press:  28 April 2016

Michael L. Rinke ,
Dominique Jan ,
Janelle Nassim ,
Jaeun Choi  and
Steven J. Choi
Michael L. Rinke*
Affiliation:
Department of Pediatrics, Children’s Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, New York
Dominique Jan
Affiliation:
Department of Surgery, Children’s Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, New York
Janelle Nassim
Affiliation:
Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida
Jaeun Choi
Affiliation:
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
Steven J. Choi
Affiliation:
Department of Pediatrics, Children’s Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, New York
*
Address correspondence to Michael L. Rinke, MD, PhD, Children’s Hospital at Montefiore and Albert Einstein College of Medicine, 3415 Bainbridge Ave, Rosenthal 1, Bronx, NY 10467 (mrinke@montefiore.org).
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Abstract

OBJECTIVE

To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes.

DESIGN

Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition.

SETTING

Urban pediatric tertiary care center April 1, 2009-March 31, 2014.

METHODS

SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case–rest of cohort, and case-control, designs.

RESULTS

In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2–6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (P<.0001), and respiratory (P=.01) surgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%–91.33%) and specificity was 99.94% (99.89%–99.97%).

CONCLUSIONS

SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children.

Infect Control Hosp Epidemiol 2016;37:931–938

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 8 , August 2016 , pp. 931 - 938
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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