SSI incidence varies dramatically among 5 groups of surgical procedures

Surgical site infection incidence varies considerably among clinically defined procedures in five National Healthcare Safety Network surgery categories, according to a study published in the American Journal of Infection Control.

Researchers compared SSI incidence data for five NHSN subgroups, including amputation, breast, colon, hernia and bile duct-liver-pancreas procedures using ICD-9-CM procedure codes in community hospitals in California, Florida and New York from January 2009 to September 2011.

All total, they reviewed SSI data for 62,901 amputation procedures, 72,058 breast procedures, 125,689 colon procedures, 85,745 hernia procedures and 33,358 bile duct-liver-pancreas procedures.

The researchers found a great deal of variety both among and within each NHSN subgroup. Highlighted below are the SSI rates for different procedures within each of the five subgroups studied.

Among amputation surgeries, the SSI rate was lowest for upper-limb amputation (6.8 percent) and highest for ankle and foot amputation (17.9 percent), both of which were very different than toe amputation (12.8 percent), the most common amputation procedure.

Bile duct-liver-pancreas
SSI rates after laparoscopic liver, bile duct, and pancreas procedures were 2.2 percent, 7.2 percent, and 17.2 percent, respectively, all of which vary significantly from the SSI incidence rate of open liver procedures (11.1 percent).

Mastectomy plus flap procedures (with an SSI rate of 4.8 percent) and mastectomy plus insertion of an expander-implant procedures (5.1 percent) both had higher SSI rates than mastectomies alone (2.3 percent).

Open colectomies alone had a significantly lower SSI rate (15.7 percent) than open colectomies performed with small bowel (29.3 percent), exploratory laparotomy (21.5 percent) or colostomy (32.2 to 52.5 percent) procedures. The SSI incidence was similar between open colectomies and open colectomies with either appendix (16.2 percent) or rectum (18.7 percent) surgeries.

Incisional-anterior abdominal hernia procedures had considerably higher SSI rates (6.1 percent) than umbilical (4.3 percent) and inguinal-femoral (1.9 percent) procedures.

"In general, the overall SSI incidence of a category differed from the SSI incidence of the individual subgroups," wrote the study authors. "In addition, SSI rates were generally higher when follow-up was not censored at the time of a subsequent surgery within 90 days."

According to the study authors, risk adjustment for specific surgery types is needed to make valid comparisons between hospitals.



More articles on SSIs:
Parkland slashes CLABSI, CAUTI, SSI rates through HAI reduction program
MRSA decontamination reduces risk for SSIs in orthopedic surgery
Triclosan-coated sutures can help prevent SSIs, study finds

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