The chance of a clinically significant infection after ambulatory surgery is relatively small; nonetheless, outpatient surgery related infections account for roughly one in five healthcare-associated infections. That seeming contradiction is explained by the fact that ambulatory surgery accounts for more than 63% of all operations in the U.S., so the absolute number of affected patients is large, according to Claudia Steiner, MD, of the Agency for Healthcare Research and Quality in Rockville, Md., and colleagues. In the inpatient setting, surgical site infections are known to be an important problem, Steiner and colleagues noted, accounting for between 20% and 31% of healthcare-associated infections.
Steiner and colleagues conducted an analysis using 2010 data from the State Ambulatory Surgery and State Inpatient Databases for eight geographically dispersed states, which together represent a third of the U.S. population. It included outcomes from 284,098 adult patients who underwent one of 12 common procedures from several surgical areas – general orthopedic, neurosurgical, gynecologic, and urologic surgery. The analysis shows rate for 14- and 30-day post-surgical acute care visits for SSI following the procedure, as well as for all-cause visits at the same times.
They found:
- Within 14 days, the overall rate of visits for SSI was 3.09 per 1,000 procedures, while extending the time frame to 30 days resulted in a rate of 4.84 visits per 1,000 procedures.
- The 14- and 30-day rates for all-cause visits, on the other hand, were 19.99 and 33.62 per 1,000 procedures, respectively.
- 63.7% of all visits for surgical site infections occurred within 14 days of the surgery and 93.2% required inpatient treatment.
The rate of visits for infections varied by procedure, the researchers reported. For instance, at 14 days, the rate was 0.27 per 1,000 laparoscopic repairs of inguinal or femoral hernias to 6.44 per 1,000 vaginal hysterectomies.
One implication of the findings is that routine follow-up after surgery — usually more than 2 weeks — should be shorter. “Earlier access to a clinician or member of the surgical team may help identify and treat these infections early and reduce overall morbidity,” they argued.
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