Surgical site infection surveillance in Australian public and private hospitals: a comparative analysis

To utilise data submitted to the state coordinating centre for healthcare-associated infection surveillance to compare surgical site infection outcomes (SSIs) in public and private hospitals in Victoria, Australia.

Coronary artery bypass graft, caesarean section (CSEC), hip (HPRO) and knee prostheses procedures reported between 2020 and 2023 were analysed. Patient characteristics included age, gender and American Society of Anaesthesiology (ASA) score. Procedure characteristics included duration, infection and surgical antibiotic prophylaxis. Logistic regression was used to model odds of SSI adjusted for patient and procedure characteristics.

This study analysed 153,264 records. Public hospitals reported more coronary artery bypass graft and CSEC procedures; private hospitals more knee prostheses and HPRO. Public hospital patients were generally younger, with longer procedure durations. Public hospitals reported more emergency procedures, proportionally more patients in high-risk categories, and longer lengths of stay for coronary artery bypass graft and HPRO. Odds of SSI were 51% lower in private hospitals for CSEC, but comparable for other procedures. Surgical antibiotic prophylaxis choice, timing and duration compliance was higher in public hospitals, except for CSEC and HPRO timing compliance, which was higher in private hospitals.

In addition to patient and procedure characteristics, hospital sector is an important consideration when interpreting SSI data. For the studied procedures, although SSI outcomes were largely comparable across public and private sectors, public hospitals performed more emergency procedures and had a higher proportion of patients classified as high risk. Further studies comparing public and private hospitals should consider additional patient factors, including comorbidities, to better identify risks and inform prevention activities.