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Incidence and Relative Burden of Surgical Site Infections in Children Undergoing Nonemergent Surgery: Implications
Katherine He1, Marie Iwaniuk2, Michael J Goretsky3
1Department of Surgery, Boston Children's Hospital, Boston, MA.
Insights
A few pediatric surgical procedures cause most surgical site infections (SSIs). This study identifies high-burden procedures to guide targeted SSI prevention efforts in pediatric surgery.
Area of Science:
- Pediatric Surgery
- Infection Control
- Healthcare Analytics
Background:
- Epidemiology of surgical site infections (SSIs) in pediatric surgery is not well understood.
- Lack of established performance benchmarks for SSIs in this population.
Purpose of the Study:
- Establish performance benchmarks for SSIs in pediatric surgery.
- Develop a framework to prioritize SSI prevention strategies based on procedure-level SSI burden.
Main Methods:
- Multicenter analysis of SSI data from NSQIP-Pediatric and procedural volume data from PHIS.
- Calculated incisional and organ space SSI (OSI) rates for 17 elective pediatric procedures.
- Extrapolated SSI burden using procedural volume and identified high-contributing procedures.
Main Results:
- Highest incisional SSI rates: gastrostomy closure (4.1%), small bowel procedures (4.0%), gastrostomy (3.7%).
- Highest OSI rates: esophageal atresia/tracheoesophageal fistula repair (8.1%), colorectal procedures (1.8%), small bowel procedures (1.5%).
- Three procedure groups accounted for 66.1% of incisional SSI burden and 72.8% of OSI events.
Conclusions:
- A small subset of pediatric surgical procedures disproportionately contributes to the overall SSI burden.
- Findings provide a framework to focus SSI prevention efforts on high-impact procedures.
Objective:
To establish surgical site infection (SSI) performance benchmarks in pediatric surgery and to develop a prioritization framework for SSI prevention based on procedure-level SSI burden.
Background:
Contemporary epidemiology of SSI rates and event burden in elective pediatric surgery remain poorly characterized.
Methods:
Multicenter analysis using sampled SSI data from 90 hospitals participating in NSQIP-Pediatric and procedural volume data from the Pediatric Health Information System (PHIS) database. Procedure-level incisional and organ space SSI (OSI) rates for 17 elective procedure groups were calculated from NSQIP-Pediatric data and estimates of procedure-level SSI burden were extrapolated using procedural volume data. The relative contribution of each procedure to the cumulative sum of SSI events from all procedures was used as a prioritization framework.
Results:
A total of 11,689 nonemergent procedures were included. The highest incisional SSI rates were associated with gastrostomy closure (4.1%), small bowel procedures (4.0%), and gastrostomy (3.7%), while the highest OSI rates were associated with esophageal atresia/tracheoesophageal fistula repair (8.1%), colorectal procedures (1.8%), and small bowel procedures (1.5%). 66.1% of the cumulative incisional SSI burden from all procedures were attributable to 3 procedure groups (gastrostomy: 27.5%, small bowel: 22.9%, colorectal: 15.7%), and 72.8% of all OSI events were similarly attributable to 3 procedure groups (small bowel: 28.5%, colorectal: 26.0%, esophageal atresia/tracheoesophageal fistula repair: 18.4%).
Conclusions:
A small number of procedures account for a disproportionate burden of SSIs in pediatric surgery. The results of this analysis can be used as a prioritization framework for refocusing SSI prevention efforts where they are needed most.
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