Pediatric surgical site infection (SSI) following ambulatory surgery: Incidence, risk factors and patient outcomes
Related Experiment Video
Updated: Oct 25, 2025
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Michael L Rinke1,2, David G Bundy3, Moonseong Heo4
1Children's Hospital at Montefiore, Bronx, New York.
Insights
Pediatric ambulatory surgery patients can develop surgical site infections (SSIs), with an incidence of 2.00 per 1,000 surgeries. Risk factors include wound class, insurance, and weekend surgery, leading to significant morbidity.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Healthcare Quality Improvement
Background:
- Inpatient surgical site infections (SSIs) are a known cause of morbidity in children.
- The incidence and risk factors for SSIs in pediatric ambulatory surgery patients are less understood.
- This study addresses the knowledge gap regarding SSIs in this specific patient population.
Purpose of the Study:
- To determine the incidence of surgical site infections (SSIs) in pediatric ambulatory surgery.
- To identify key risk factors associated with SSIs in this setting.
- To understand the outcomes and associated morbidity of SSIs following pediatric ambulatory surgery.
Main Methods:
- A multi-institution, retrospective epidemiologic study was conducted.
- Electronic queries identified patients aged <22 years undergoing ambulatory surgery between 2010-2015.
- Chart reviews confirmed SSIs, and weighted Poisson rates and case-control logistic regression were used to analyze incidence and risk factors.
Main Results:
- A total of 45 SSIs were identified among 13,795 reviewed charts, yielding a weighted incidence of 2.00 SSIs per 1,000 pediatric ambulatory surgeries.
- Integumentary surgeries showed the highest incidence (3.24 per 1,000).
- Significant risk factors for SSI included contaminated/clean-contaminated wounds (OR 9.8), non-private insurance (OR 4.0), and weekend surgeries (OR 30).
Conclusions:
- Surgical site infections (SSIs) following pediatric ambulatory surgery are associated with significant morbidity.
- A substantial proportion of infected patients required hospital admission (40%) or further surgical intervention (36%).
- Findings highlight potential targets for intervention to reduce SSI rates and improve patient outcomes.
Background:
Inpatient surgical site infections (SSIs) cause morbidity in children. The SSI rate among pediatric ambulatory surgery patients is less clear. To fill this gap, we conducted a multiple-institution, retrospective epidemiologic study to identify incidence, risk factors, and outcomes.
Methods:
We identified patients aged <22 years with ambulatory visits between October 2010 and September 2015 via electronic queries at 3 medical centers. We performed sample chart reviews to confirm ambulatory surgery and adjudicate SSIs. Weighted Poisson incidence rates were calculated. Separately, we used case-control methodology using multivariate backward logistical regression to assess risk-factor association with SSI.
Results:
In total, 65,056 patients were identified by queries, and we performed complete chart reviews for 13,795 patients; we identified 45 SSIs following ambulatory surgery. The weighted SSI incidence following pediatric ambulatory surgery was 2.00 SSI per 1,000 ambulatory surgeries (95% confidence interval [CI], 1.37-3.00). Integumentary surgeries had the highest weighted SSI incidence, 3.24 per 1,000 ambulatory surgeries (95% CI, 0.32-12). The following variables carried significantly increased odds of infection: clean contaminated or contaminated wound class compared to clean (odds ratio [OR], 9.8; 95% CI, 2.0-48), other insurance type compared to private (OR, 4.0; 95% CI, 1.6-9.8), and surgery on weekend day compared to weekday (OR, 30; 95% CI, 2.9-315). Of the 45 instances of SSI following pediatric ambulatory surgery, 40% of patients were admitted to the hospital and 36% required a new operative procedure or bedside incision and drainage.
Conclusions:
Our findings suggest that morbidity is associated with SSI following ambulatory surgery in children, and we also identified possible targets for intervention.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:28Asepsis