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Surgical Urgency, Patient Comorbidities, and Socioeconomic Factors in Surgical Site Infections in Pediatric Surgery
Luis Alejandro Quintero1, Jennifer Hernandez1, Nancy Orduno Villa1
1General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA.
Insights
Pediatric gastrointestinal surgery patients face a 2.9% risk of surgical site infections (SSI). Trauma, emergency procedures, and multiple comorbidities increase this risk, while high-income hospitals show a decreased risk.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Health Services Research
Background:
- Value-based purchasing models reduce compensation for hospital-acquired conditions like surgical site infections (SSI).
- Understanding pediatric SSI risk factors is crucial for improving patient outcomes and hospital reimbursement.
- This study investigates risk factors for SSI in pediatric gastrointestinal surgery patients.
Purpose of the Study:
- To identify risk factors associated with surgical site infections (SSI) in pediatric and adolescent patients undergoing gastrointestinal surgery.
- To analyze the impact of surgical urgency, anatomical location, comorbidities, and hospital characteristics on SSI rates.
- To inform strategies for mitigating SSI and advocating for appropriate risk adjustment in payment systems.
Main Methods:
- Utilized the 2018-2020 Nationwide Readmissions Database, including patients under 18 undergoing gastrointestinal surgery.
- Defined the primary outcome as SSI during index admission or within one year of readmission.
- Employed chi-squared tests for univariable analysis and multivariable logistic regression to control for confounders.
Main Results:
- A total of 113,108 patients were analyzed, with an overall SSI rate of 2.9%.
- Risk factors for SSI included trauma (OR 1.80), emergency surgery (OR 1.31), large bowel surgery (OR 2.78), and ≥3 comorbidities (OR 2.03).
- Investor-owned hospitals (OR 0.65) and highest quartile income settings (OR 0.80) were associated with reduced SSI risk.
Conclusions:
- Pediatric gastrointestinal surgery patients, particularly those undergoing trauma or emergency procedures with multiple comorbidities, have a higher risk of SSI.
- High-income and investor-owned hospital settings demonstrated a lower risk of SSI.
- Risk adjustment in value-based payment systems is recommended for hospitals and surgeons managing high-risk pediatric patients.
Background:
The rise of value-based purchasing has led to decreased compensation for hospital-acquired conditions, including surgical site infections (SSI). This study aims to assess the risk factors for SSI in children and teenagers undergoing gastrointestinal surgery across US hospitals.
Methods:
The 2018-2020 Nationwide Readmissions Database was queried for patients undergoing gastrointestinal surgery under the age of 18. The primary outcome was SSI during index admission or readmission within a year. Comparison groups were elective, trauma, and emergent surgery based on anatomic location and urgency. Univariable comparison used chi-squared tests for relevant variables. Confounders were addressed through multivariable logistic regression with significant variables from univariable analysis.
Results:
113 108 total patients met the study criteria. The SSI rate during admission or readmission was 2.9% (n = 3254). Infections during admission and readmission were 1.4% (n = 1560) and 1.5% (n = 1694), respectively. The most common site was organ space (48.6%, n = 1657). Increased infection risk was associated with trauma (OR 1.80 [1.51-2.16] P < .001), emergency surgery (OR 1.31 [1.17-1.47] P < .001), large bowel surgery (OR 2.78 [2.26-3.43] P < .001), and those with three or more comorbidities (OR 2.03 [1.69-2.45] P < .001). Investor-owned hospitals (OR .65 [.56-.76] P < .001) and highest quartile income (OR .80 [.73-.88] P < .001) were associated with decreased infection risk.
Conclusions:
Pediatric patients undergoing gastrointestinal surgery face an elevated risk of SSI, especially in trauma and emergency surgeries, particularly with multiple comorbidities. Meanwhile, a reduced risk is observed in high-income and investor-owned hospital settings. Hospitals and surgeons caring for high risk patients should advocate for risk adjustment in value-based payment systems.
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