Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-05-14T04:10:41.041Z Has data issue: false hasContentIssue false
  • English
  • Français

Is There Room for Prevention? Examining the Effect of Outpatient Facility Type on the Risk of Surgical Site Infection

Published online by Cambridge University Press:  19 July 2016

Rishi Parikh ,
Daniel Pollock ,
Jyotirmay Sharma  and
Jonathan Edwards
Rishi Parikh*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Daniel Pollock
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Jyotirmay Sharma
Affiliation:
Department of Surgery, The Emory Clinic, Atlanta, Georgia
Jonathan Edwards
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to Rishi V. Parikh, MPH, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road Mailstop A-24, Atlanta, Georgia 30329-4027 (yfp2@cdc.gov).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

We compared risk for surgical site infection (SSI) following surgical breast procedures among 2 patient groups: those whose procedures were performed in ambulatory surgery centers (ASCs) and those whose procedures were performed in hospital-based outpatient facilities.

DESIGN

Cohort study using National Healthcare Safety Network (NHSN) SSI data for breast procedures performed from 2010 to 2014.

METHODS

Unconditional multivariate logistic regression was used to examine the association between facility type and breast SSI, adjusting for American Society of Anesthesiologists (ASA) Physical Status Classification, patient age, and duration of procedure. Other potential adjustment factors examined were wound classification, anesthesia use, and gender.

RESULTS

Among 124,021 total outpatient breast procedures performed between 2010 and 2014, 110,987 procedure reports submitted to the NHSN provided complete covariate data and were included in the analysis. Breast procedures performed in ASCs carried a lower risk of SSI compared with those performed in hospital-based outpatient settings. For patients aged ≤51 years, the adjusted risk ratio was 0.36 (95% CI, 0.25–0.50) and for patients >51 years old, the adjusted risk ratio was 0.32 (95% CI, 0.21–0.49).

CONCLUSIONS

SSI risk following breast procedures was significantly lower among ASC patients than among hospital-based outpatients. These findings should be placed in the context of study limitations, including the possibility of incomplete ascertainment of SSIs and shortcomings in the data available to control for differences in patient case mix. Additional studies are needed to better understand the role of procedural settings in SSI risk following breast procedures and to identify prevention opportunities.

Infect Control Hosp Epidemiol 2016;1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 10 , October 2016 , pp. 1179 - 1185
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Magill, SS, Edwards, JR, Bamberg, W, Beldavs, ZG, Dumyati, G, Kainer, MA. Multistate point-prevalence survey of health care–associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
2. Awad, S.S.. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt) 2012;13:234–237.CrossRefGoogle ScholarPubMed
3. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.CrossRefGoogle ScholarPubMed
4. Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical‐site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.CrossRefGoogle ScholarPubMed
5. Scott II, RD. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Centers for Disease Control and Prevention website. http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf. Published 2009. Accessed June 3, 2016.Google Scholar
6. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care–associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle ScholarPubMed
7. Umscheid, CA, et al. 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.CrossRefGoogle ScholarPubMed
8. Mu, Y, Edwards, JR, Horan, TC, et al. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol 2011;32:970–986.CrossRefGoogle ScholarPubMed
9. Cullen, KA, Hall, MJ, Golosinskiy, A. Ambulatory surgery in the United States, 2006. Nat Health Stat Rept 2009;11:1–25.Google Scholar
10. Mannien, J, Wille, JC, Snoeren, RL, van den Hof, S. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands. Infect Control Hosp Epidemiol 2006;27:809–816.CrossRefGoogle Scholar
11. Vilar-Compte, D, Jacquemin, B, Robles-Vidal, C, Volkow, P. Surgical site infections in breast surgery: case-control study. World J Surg 2004;28:242–246.CrossRefGoogle ScholarPubMed
12. Vilar-Compte, D, Rosales, S, Hernandez-Mello, N, Maafs, E, Volkow, P. Surveillance, control, and prevention of surgical site infections in breast cancer surgery: a 5-year experience. Am J Infect Control 2009;37:674–679.CrossRefGoogle Scholar
13. Olsen, MA, Chu-Ongsakul, S, Brandt, KE, et al. Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg 2008;143:53–60.CrossRefGoogle ScholarPubMed
14. Olsen, MA, Lefta, M, Dietz, JR, et al. Risk factors for surgical site infection after major breast operation. J Amer Col Surg 2008;207:326–335.CrossRefGoogle ScholarPubMed
15. National Healthcare Safety Network Patient Safety Component Manual. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Updated April 2015. Accessed July 2015.Google Scholar
16. ASA Physical Status Classification System. American Society of Anesthesiologists website. http://www.asahq.org/clinical/physicalstatus.htm. Accessed July 2015.Google Scholar
17. Petherick, ES, Dalton, JE, Moore, PJ, Cullum, N. Methods for identifying surgical wound infection after discharge from hospital: a systematic review. BMC Infectious Diseases 2006;6:170.CrossRefGoogle ScholarPubMed
18. Gase, KA, Kelly, L, Hohrein, M, Siebels, K, Babcock, HM. The National Healthcare Safety Network and the National Surgical Quality Improvement Program: discrepancies in reported surgical site infection rates. Am J Infect Control 2015;43:S16–S17.CrossRefGoogle Scholar
19. Xue, DQ, et al. Risk factors for surgical site infections after breast surgery: a systematic review and meta-analysis. Eur J Surg Oncol 2012;38:375–381.CrossRefGoogle ScholarPubMed
20. Davis, GB, et al. Identifying risk factors for surgical site infections in mastectomy patients using the National Surgical Quality Improvement Program database. Am J Surg 2013;205:194–199.CrossRefGoogle ScholarPubMed
21. Rey, JE, Gardner, SM, Cushing, RD. Determinants of surgical site infection after breast biopsy. Am J Infect Control 2005;33:126–129.CrossRefGoogle ScholarPubMed
22. Bertin, ML, Crowe, J, Gordon, SM. Determinants of surgical site infection after breast surgery. Am J Infect Control 1998;26:61–65.CrossRefGoogle ScholarPubMed
23. Kaye, KS, Schmit, K, Pieper, C, et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis 2005;191:1056–1062.CrossRefGoogle ScholarPubMed
24. Gaynes, R, Richards, C, Edwards, J, et al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295.CrossRefGoogle ScholarPubMed
25. Gaynes, R, Culver, D, Horan, TC, Edwards, JR, Richards, C, Tolson, JS. Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clinical Infectious Diseases 2001;33:S69–S77.CrossRefGoogle ScholarPubMed
Supplementary material: File

Parikh supplementary material

Tables A1-A2

Download Parikh supplementary material(File)
File 19 KB