Abstract
Background
Despite the introduction of several measures to reduce incidence, postoperative infections
have been reported to increase. We aimed to assess trends in the incidence and impact
of postoperative infections using a recent national cohort.
Methods
Patients undergoing the most commonly performed elective inpatient procedures in 9
surgical specialties were identified from the 2006 to 2014 National Inpatient Sample.
Diagnostic coding was utilized to identify patients with postoperative infections.
To adjust for patient and operative differences in assessing outcomes, an inverse
probability of treatment weighing protocol was used.
Results
Of an estimated 23,696,588 patients, 1,213,182 (5.1%) developed postoperative infections.
Skin and soft tissue operations had the highest burden (12.9%) and endocrine the lowest
(1.3%). During the study period, we found decreasing incidence, case fatality, and
incremental cost of postoperative infections. Infection was associated with increased
in-hospital mortality (1.4 vs 0.4%, P < .001), duration of stay (7.6 vs 3.7 days, P < .001), and costs ($27,597 vs $17,985, P < .001). Annually, postoperative infections led to an average incremental cost burden
exceeding $700 million in the United States alone.
Conclusion
During the study period there was a substantial decrease in the burden of postoperative
infections. Despite encouraging trends, postoperative infections continue to serve
as a suitable quality improvement target, particularly in specialties with a high
burden of infections.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017.JAMA Surg. 2017; 152: 784-791
- Surgical site infection: incidence and impact on hospital utilization and treatment costs.Am J Infect Control. 2009; 37: 387-397
- Post-operative infections: trends in distribution, risk factors, and clinical and economic burdens.Surg Infect (Larchmt). 2018; 19: 717-722
- The surgical care improvement project and prevention of post-operative infection, including surgical site infection.Surg Infect (Larchmt). 2011; 12: 163-168
- The power of the National Surgical Quality Improvement Program: achieving a zero pneumonia rate in general surgery patients.Perm J. 2012; 16: 39-45
- Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery.Anesthesiology. 2010; 112: 917-925
- The epidemiology and risk factors for postoperative pneumonia.J Clin Med Res. 2017; 9: 466-475
HCUP Databases. Healthcare Cost and Utilization Project (HCUP). December 2019. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed February 2, 2020.
NIS Description of Data Elements. Healthcare Cost and Utilization Project (HCUP). August 2018. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/nation/nis/nisdde.jsp. Accessed February 2, 2020.
- Comorbidity measure for use with administrative data.Med Care. 1998; 36: 8-27
- A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.Med Care. 2009; 47: 626-633
- Propensity score methods for confounding control in nonexperimental research.Circ Cardiovasc Qual Outcomes. 2013; 6: 604-611
- The effect of Surgical Care Improvement Project measures on national trends on surgical site infections in open vascular procedures.J Vasc Surg. 2014; 60: 1635-1639
- Surgical site infection prevention: time to move beyond the surgical care improvement program.Ann Surg. 2011; 254 (discussion 499-501): 494-499
- Adherence to surgical care improvement project measures and the association with postoperative infections.JAMA. 2010; 303: 2479-2485
- Long-term results of a postoperative pneumonia prevention program for the inpatient surgical ward.JAMA Surg. 2014; 149: 914-918
- Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee.MMWR Recomm Rep. 2004; 53: 1-36
- Estimating health care-associated infections and deaths in US hospitals, 2002.Public Health Rep. 2007; 122: 160-166
- Surgical duration and risk of Urinary Tract Infection: an analysis of 1,452,369 patients using the National Surgical Quality Improvement Program (NSQIP).Int J Surg. 2015; 20: 107-112
- Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs.Infect Control Hosp Epidemiol. 2011; 32: 101-114
- Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program.Trans. 2009; 127: 7-20
- Improving surgical site infections: ssing National Surgical Quality Improvement Program data to institute surgical care improvement project protocols in improving surgical outcomes.J Am Coll Surg. 2010; 210: 737-741
- Improved surgical outcomes for ACS NSQIP hospitals over time.Ann Surg. 2016; 263: 267-273
ACS NSQIP Hospitals. https://www.facs.org/search/nsqip-participants. Accessed February 2, 2020.
Article info
Publication history
Published online: June 28, 2020
Accepted:
April 27,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
