Surgical Site Infections Following Ambulatory Surgery Procedures
ABSTRACT Surgical site infections can result in substantial morbidity following inpatient surgery. Little is known about serious infections following ambulatory surgery.
To determine the incidence of clinically significant surgical site infections (CS-SSIs) following low- to moderate-risk ambulatory surgery in patients with low risk for surgical complications.
Retrospective analysis of ambulatory surgical procedures complicated by CS-SSIs that require a postsurgical acute care visit (defined as subsequent hospitalization or ambulatory surgical visit for infection) using the 2010 Healthcare Cost and Utilization Project State Ambulatory Surgery and State Inpatient Databases for 8 geographically dispersed states (California, Florida, Georgia, Hawaii, Missouri, Nebraska, New York, and Tennessee) representing one-third of the US population. Index cases included 284 098 ambulatory surgical procedures (general surgery, orthopedic, neurosurgical, gynecologic, and urologic) in adult patients with low surgical risk (defined as not seen in past 30 days in acute care, length of stay less than 2 days, no other surgery on the same day, and discharged home and no infection coded on the same day).
Rates of 14- and 30-day postsurgical acute care visits for CS-SSIs following ambulatory surgery.
Postsurgical acute care visits for CS-SSIs occurred in 3.09 (95% CI, 2.89-3.30) per 1000 ambulatory surgical procedures at 14 days and 4.84 (95% CI, 4.59-5.10) per 1000 at 30 days. Two-thirds (63.7%) of all visits for CS-SSI occurred within 14 days of the surgery; of those visits, 93.2% (95% CI, 91.3%-94.7%) involved treatment in the inpatient setting. All-cause inpatient or outpatient postsurgical visits, including those for CS-SSIs, following ambulatory surgery occurred in 19.99 (95% CI, 19.48-20.51) per 1000 ambulatory surgical procedures at 14 days and 33.62 (95% CI, 32.96-34.29) per 1000 at 30 days.
Among patients in 8 states undergoing ambulatory surgery, rates of postsurgical visits for CS-SSIs were low relative to all causes; however, they may represent a substantial number of adverse outcomes in aggregate. Thus, these serious infections merit quality improvement efforts to minimize their occurrence.
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ABSTRACT: Background The rapidly changing landscape of percutaneous coronary intervention provides a unique model for examining disparities over time. Previous studies have not examined socioeconomic inequalities in the current era of drug eluting stents (DES). Methods and Results We analyzed 835 070 hospitalizations for acute coronary syndrome (ACS) from the Healthcare Cost and Utilization Project across all insurance types from 2008 to 2011, examining whether quality of care and outcomes for patients with ACS differed by income (based on zip code of residence) with adjustment for patient characteristics and clustering by hospital. We found that lower‐income patients were less likely to receive an angiogram within 24 hours of a ST elevation myocardial infarction (STEMI) (69.5% for IQ1 versus 73.7% for IQ4, P<0.0001, OR 0.79 [0.68 to 0.91]) or within 48 hours of a Non‐STEMI (47.6% for IQ1 versus 51.8% for IQ4, P<0.0001, OR 0.86 [0.75 to 0.99]). Lower income was associated with less use of a DES (64.7% for IQ1 versus 71.2% for IQ4, P<0.0001, OR 0.83 [0.74 to 0.93]). However, no differences were found for coronary artery bypass surgery. Among STEMI patients, lower‐income patients also had slightly increased adjusted mortality rates (10.8% for IQ1 versus 9.4% for IQ4, P<0.0001, OR 1.17 [1.11 to 1.25]). After further adjusting for time to reperfusion among STEMI patients, mortality differences across income groups decreased. Conclusions For the most well accepted procedural treatments for ACS, income inequalities have faded. However, such inequalities have persisted for DES use, a relatively expensive and until recently, controversial revascularization procedure. Differences in mortality are significantly associated with differences in time to primary PCI, suggesting an important target for understanding why these inequalities persist.Journal of the American Heart Association 10/2014; 3(6). DOI:10.1161/JAHA.114.001029 · 2.88 Impact Factor
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ABSTRACT: We assessed 4045 ambulatory surgery patients for surgical site infection (SSI) using claims-based triggers for medical chart review. Of 98 patients flagged by codes suggestive of SSI, 35 had confirmed SSIs. SSI rates ranged from 0 to 3.2% for common procedures. Claims may be useful for SSI surveillance following ambulatory surgery. Infect Control Hosp Epidemiol 2014;00(0):1-4.Infection Control and Hospital Epidemiology 02/2015; 36(2):225-8. DOI:10.1017/ice.2014.23 · 3.94 Impact Factor
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ABSTRACT: Annually, 1.7 million patients in the US develop a healthcare-associated infection (HAI).1 The annual economic burden of the five major types of HAI in the US is estimated to be $9.8 billion, with surgical site infections (SSIs) being the greatest contributor (33.7% of total costs).2 Ambulatory surgery represents a large proportion of surgical healthcare in the US, with recent data indicating 18.7 million ambulatory surgeries performed annually.3 Data on HAI rates following ambulatory procedures in US healthcare facilities suggest that HAI prevention can present an important challenge to ambulatory surgery centers (ASCs).3 Skin flora represent an important risk factor for HAIs, and proper skin preparation prior to surgery is recognized as key to preventing complications.4 It is increasingly recognized by clinicians that interventions to standardize / limit between-surgeon variability for surgical procedures can improve outcomes and reduce the incidence of HAIs.5 The CareFusion Focus on Quality Care Program, designed to support healthcare facilities’ efforts to reduce or eliminate variability in key processes, provides a valuable tool for the assessment of surgical procedures and identification of standardization opportunities and potential means to improve outcomes. Objective The objective of this study was to assess compliance with surgical skin preparation procedures in the operating room (OR) of ASCs, and thus identify potential opportunities for prevention and control of SSIs in ASCs.2015 AORN Conference, Denver, Co; 03/2015