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Pediatric gastrointestinal surgical site infections: a case-control study
Vicky Khoury1, Erika P Viana Cardenas2, Grace M Lee1
1Department of Pediatrics, Division of Infectious Diseases, https://ror.org/03mtd9a03Stanford University School of Medicine, Palo Alto, CA, USA.
Objective:
Surgical site infections (SSIs) remain a significant source of morbidity in children. Elevated standardized infection ratios (SIRs) for pediatric gastrointestinal (GI) procedures persist nationally and at our institution. We assessed pediatric-specific risk factors and the applicability of the adult SIR model.
Design:
Case-control study of pediatric patients undergoing GI surgery (2019-2022) with 82 SSI cases matched 1:2 with 164 controls by prematurity, age, National Healthcare Safety Network (NHSN) procedure category and year. Data was collected via chart review; socioeconomic risk was assessed using the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Bivariate and multivariate conditional logistic regression analyses used to estimate adjusted odds ratios (aOR) with 95% confidence interval (CI).
Setting:
A tertiary pediatric referral center.
Patients:
Ages 0-21; NHSN reportable GI SSI procedures (appendix, gastric, small bowel, colon, laparotomy).
Results:
Cases were more likely to speak a language other than English or Spanish aOR 4.26 (95% CI, 1.06-17.11; P = .041) compared to controls. Adult SIR risk factors such as diabetes mellitus, were not significant predictors. Cases had longer hospitalizations (median 17.5 vs 7 days) and higher 30-day readmission rates (26% vs 10%) compared to controls.
Conclusions:
These findings highlight the importance of language-concordant care and consideration of other social vulnerabilities in pediatric GI surgical care. Adult-based SIR models may not be applicable to children, highlighting the need for pediatric-specific measures that ensure equitable access to preventive care.
