Abstract
BackgroundSurgical site infections (SSI) remain a major clinical problem in terms of morbidity, mortality, and hospital costs. Nearly 60% of SSI diagnosis occur in the postdischarge period. However, literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence. A national prospective multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI, and the associated risk factors.MethodsIn 2002, a one-month, prospective national multicenter surveillance study was conducted in General and Gynecological units of 48 Italian hospitals. Case ascertainment of SSI was carried out using standardized surveillance methodology. To assess potential risk factors for SSI we used a conditional logistic regression model. We also reported the odds ratios of in-hospital and postdischarge SSI.ResultsSSI occurred in 241 (5.2%) of 4,665 patients, of which 148 (61.4%) during in-hospital, and 93 (38.6%) during postdischarge period. Of 93 postdischarge SSI, sixty-two (66.7%) and 31 (33.3%) were detected through telephone interview and questionnaire survey, respectively. Higher SSI incidence rates were observed in colon surgery (18.9%), gastric surgery (13.6%), and appendectomy (8.6%). If considering risk factors for SSI, at multivariate analysis we found that emergency interventions, NNIS risk score, pre-operative hospital stay, and use of drains were significantly associated with SSI occurrence. Moreover, risk factors for total SSI were also associated to in-hospital SSI. Additionally, only NNIS, pre-operative hospital stay, use of drains, and antibiotic prophylaxis were associated with postdischarge SSI.ConclusionOur study provided information on risk factors for SSI in a large population in general surgery setting in Italy. Standardized postdischarge surveillance detected 38.6% of all SSI. We also compared risk factors for in-hospital and postdischarge SSI, thus providing additional information to that of the current available literature. Finally, a large amount of postdischarge SSI were detected through telephone interview. The evaluation of the cost-effectiveness of the telephone interview as a postdischarge surveillance method could be an issue for further research.
Highlights
Surgical site infections (SSI) remain a major clinical problem in terms of morbidity, mortality, and hospital costs
The composite National Nosocomial Infection Surveillance (NNIS) risk score was found to be positively correlated to the risk of inhospital SSI [18], whereas other reports have documented a discrepancy between the predicted risk of infection by NNIS index score and the incidence of postdischarge SSI [7,8]
We found that emergency interventions, NNIS index score, and pre-operative hospital stay were independently associated to overall SSI occurrence
Summary
Surgical site infections (SSI) remain a major clinical problem in terms of morbidity, mortality, and hospital costs. Literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence. A national prospective multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI, and the associated risk factors. Surgical site infections (SSI) remain a major clinical problem in terms of morbidity, mortality [1], length of stay and hospital costs [2,3,4]. 60% of SSI diagnosis, ranging from 21 to 100%, [5,6,7,8,9] occur after hospital discharge and the trend increases as the length of postoperative hospital stay is getting shorter and the number of one day surgery procedures enlarges over time. The composite National Nosocomial Infection Surveillance (NNIS) risk score was found to be positively correlated to the risk of inhospital SSI [18], whereas other reports have documented a discrepancy between the predicted risk of infection by NNIS index score and the incidence of postdischarge SSI [7,8]
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