Risk Factors and Outcomes of Surgical Site Infection in Children

Bucher, Brian T.; Guth, Rebecca M.; Elward, Alexis; Hamilton, Nicholas A.; Dillon, Patrick A.; Warner, Brad W.; Keller, Martin S.

doi:10.1016/j.jamcollsurg.2011.01.065

Cited by 58 publications

(57 citation statements)

References 17 publications

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“…Neonates are presumed to be at higher risk of SSI due to a greater immunological vulnerability and specific co-morbidities [6] including prematurity [2,7] and prolonged parenteral nutrition dependence [8]. Also, neonates are commonly exposed to pre-operative antibiotics, raising additional concerns of microbial resistance [9].…”

Section: Introductionmentioning

confidence: 99%

Surgical site infections in infants admitted to the neonatal intensive care unit

Segal¹,

Kang

Albersheim

et al. 2014

Journal of Pediatric Surgery

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Section: Introductionmentioning

confidence: 99%

Surgical site infections in infants admitted to the neonatal intensive care unit

Segal¹,

Kang

Albersheim

et al. 2014

Journal of Pediatric Surgery

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“…The codes used in this study were chosen for their unambiguous definition and applicability to all surgeries, not certain surgical subgroups, and their prior usage. 4 The SSI rates presented in this study use the weighted 26 confirmed infections identified from either ICD-9 codes or the random chart sampling methodology. It is possible that additional infections exist in the 95% of charts not directly screened, and/or additional SSIs would have been found if we had employed prospective data collection, leading to higher SSI rates.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Pediatric SSI rates have been reported as high as 1 to 3.4 infections per 100 surgeries, with risk factors including neonatal age, African American race, failure to thrive diagnosis, and urinary catheter placement. [3][4][5] Many children receive ambulatory surgical care, and significantly less is known about SSIs following ambulatory surgery. Recent adult SSI studies following ambulatory surgery found SSI rates from 3 to 10 infections per 1,000 surgeries, and administrative billing codes demonstrating only 36% positive predictive value.…”

mentioning

confidence: 99%

Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis

Rinke

Jan

Nassim

et al. 2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case-rest of cohort, and case-control, designs. RESULTS In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2-6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (P<.0001), and respiratory (P=.01) surgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938.

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“…It is also interesting to note that Bucher and colleagues discovered a racial predisposition to SSI among children [26]. In their study, children of African descent were more likely to develop SSI.…”

Section: The African Perspectivementioning

confidence: 91%

“…Likewise, in a retrospective, case-control study restricted to clean and clean-contaminated cases, Bucher and colleagues found that \1% of children developed SSIs at the St. Louis Children's Hospital during a 12-year period [26]. They also identified several risk factors for surgical site infection in their patient population.…”

Section: The African Perspectivementioning

confidence: 99%