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Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort
Insights
Surgical site infections (SSIs) are more common in children in low-income countries. This global study highlights the need for policies to reduce pediatric SSIs worldwide.
Area of Science:
- Global Health
- Pediatric Surgery
- Infectious Diseases
Background:
- Surgical site infection (SSI) is a common healthcare-associated infection (HAI).
- Data on pediatric SSI incidence and outcomes, particularly in low- and middle-income countries, is limited.
- Understanding SSI risk factors across different human development settings is crucial for global health initiatives.
Purpose of the Study:
- To estimate the incidence of pediatric SSI globally.
- To investigate associations between SSI and morbidity in children across varying human development settings.
- To identify disparities in SSI rates based on country income levels.
Main Methods:
- A multicentre, international, prospective cohort study involving children under 16 undergoing gastrointestinal surgery.
- Data collected from hospitals worldwide between January and July 2016.
- Countries stratified by United Nations Human Development Index (HDI); SSI incidence and associated factors analyzed using multilevel logistic regression.
Main Results:
- The 30-day SSI incidence was 6.3% in high HDI, 12.8% in middle HDI, and 24.7% in low HDI countries.
- Pediatric SSI was linked to increased 30-day mortality, need for intervention, organ-space infections, and other HAIs.
- Laparoscopic surgery was associated with significantly lower SSI rates, irrespective of HDI.
Conclusions:
- Children in low HDI countries have nearly four times the odds of developing SSI compared to those in high HDI countries.
- Global policies to prioritize and reduce pediatric SSI are urgently needed.
- Addressing disparities in SSI rates is essential for improving child surgical outcomes worldwide.
Introduction:
Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings.
Methods:
A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI).
Results:
Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI.
Conclusion:
The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.
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