Surveying the Surveillance: Surgical Site Infections Excluded by the January 2013 Updated Surveillance Definitions

Abstract

The updated 2013 Centers for Disease Control and Prevention/ National Healthcare Safety Network definitions for surgical site infections (SSIs) reduced the duration of prolonged surveillance from 1 year to 90 days and defined which procedure types require prolonged surveillance. Applying the updated 2013 SSI definitions to cases analyzed using the pre-2013 surveillance definitions excluded 10% of previously identified SSIs.

Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration

“…After 90 days, only a few more SSIs were detected, triggering discussion about whether those late SSIs are truly due to preventable issues during the operation [16]. Three of the five studies mentioned [15][16][17] confirm our finding that more SSIs are missed after knee-replacement surgery than after hip replacement surgery when the follow-up is reduced to 90 days.…”

“…To the best of our knowledge, no European studies and only a few American and Canadian studies have analysed timing of SSIs to quantify the impact of a shorter PDS duration [10,[15][16][17][18]. None of these studies used survival techniques to visually demonstrate the accumulation of SSIs over time.…”

“…The vast majority of SSIs were detected within a 90-day window [10,[15][16][17][18], varying from about 70% [10] to 100% [17]. After 90 days, only a few more SSIs were detected, triggering discussion about whether those late SSIs are truly due to preventable issues during the operation [16].…”

“…For reasons of simplicity and to reduce the burden of performing PDS, the United States Centers for Disease Control and Prevention (CDC) in summer 2013 decided to link the duration of PDS to the type of surgery instead of the presence of implants, and to reduce the maximum duration of PDS from one year to 90 days [9,10]. Although not officially published yet, for similar reasons, the European Centre for Disease Prevention and Control (ECDC) adopted the 90-day PDS for implant surgeries in 2014 (C. Suetens, personal communication, 15 December 2014). By making these changes, the international consensus on the recommended duration of PDS has been lost and is currently subject to research.…”

Letter to the editor: Is a reduced duration of post-discharge surgical site infection surveillance really in our best interests?

“…Equally, the likelihood of developing an SSI significantly drops after this point. Other studies have identified comparable patterns [2]. So, clearly, redefining the end point will reduce the incidence of SSI.…”