Risk factors and surveillance for postdischarge surgical site infections: A prospective analysis

Although many hospitals have good hospital-based surveillance programs about surgical site infections (SSI), there are a limited data on the detection of postdischarge-SSI (PD-SSI). The aim of this study is to identify risk factors for SSI, and to detect PD-SSI in selected surgeries and compare it with standard surveillance data.

Patients who underwent elective cesarean section, laparoscopic cholecystectomy, total knee replacement (TKR), lumbar disc herniation surgery (LDHS), coronary artery bypass graft (CABG), total hip replacement (THR), or gastrectomy between November 1, 2023, and October 1, 2024, were included in the study. Age, gender, comorbidities, height, and weight, antibiotic prophylaxis, and inclusion in standard SSI surveillance were recorded. Patients were contacted 1 month after surgery/3 months after prosthesis placement, independently of infection control committee records, and survey questions were asked.

A total of 1232 patients were included in the study, 315 had cesarean section, 266 had laparoscopic cholecystectomy, 202 had TKR, 197 had LDHS, 155 had CABG, 67 had THR, and 30 had gastrectomy. SSI developed in 121 (9.8%) patients. While SSI was detected in only 80 patients (6.4%)using standard surveillance methods, postdischarge questionnaire evaluations identified an additional 41 patients (3.3%) with PD-SSI. Risk factors for PD-SSI (vs No-SSI) were determined as follows: BMI for cesarean section (OR: 1.118, P = 0.029), chronic kidney disease for laparoscopic cholecystectomy (OR: 6.250, P = 0.006), diabetes for TKR (OR: 3.646, P = 0.069), urinary catheterization duration for TKR (OR: 2.588, P= 0.046) DM for LDHS (OR: 4.700, P = 0.007), and high BMI for CABG (OR: 1.257, P = 0.035).

Diabetes was the most important risk factor and was consistent with the literature. It is difficult and cumbersome to include all patients who undergo surgery in postdischarge surveillance. Specifically for surgery, including patients with risk factors in postdischarge surveillance would be a more feasible strategy.