Despite low postsurgical infection rates, quality improvement needed

Although a new study reveals surgical site infection rates after ambulatory surgery are relatively low, researchers warn that the absolute number of patients with these complications is substantial.

The analysis, published in the Journal of the American Medical Association, included nearly 300,000 patients from eight states who underwent outpatient procedures. The research team used the 2010 Healthcare Cost and Utilization Project to review cases from California, Florida, Georgia, Hawaii, Missouri, Nebraska, New York and Tennessee, which combined represent a third of the U.S. population.

Researchers, led by Pamela L. Owens, Ph.D., of the Agency for Healthcare Research and Quality, looked at outpatient procedures involving general surgery, orthopedics, neurosurgery, gynecology and urology in adult patients. They then calculated the rates for 14- and 30-day postsurgical acute care visits for surgical site infections after the surgeries.

They found the overall rate of postsurgical acute care visits within 14 days for clinically significant surgical site infections (CS-SSIs) was relatively low (3.09 per 1,000 ambulatory surgical procedures). However, the rate increased over a 30-day time span to 4.84.

Furthermore, two-thirds (63.7 percent) of all visits for CS-SSI occurred within 14 days of the surgery; of the visits, 93.2 percent involved treatment in the inpatient setting.

Researchers noted that because of the large amount of ambulatory surgeries performed each year, the number of patients who develop CS-SSIs is significant. Surgical site infections are among the most common healthcare-associated infections (HAI), accounting for 20 percent to 31 percent of HAIs in hospitalized patients. Indeed, a 2013 study published in JAMA Internal Medicine found surgical site infections account for 33.7 percent of the total annual cost of HAI treatment, FierceHealthcare previously reported.

"These serious infections merit quality improvement efforts to minimize their occurrence," the study noted.

These efforts may include routine follow-up prior to the two-week mark. "Our findings suggest that earlier access to a clinician or member of the surgical team (e.g., telephone check-in prior to two weeks) may help identify and treat these infections early and reduce overall morbidity," the authors said in a study announcement.

To learn more:
- here's the study abstract
- read the announcement

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