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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, Stanford University School of Medicine, Palo Alto, CA, USA.
Insights
Language barriers increase surgical site infection (SSI) risk in pediatric GI surgery. Adult models for infection ratios may not apply to children, necessitating pediatric-specific prevention strategies.
Area of Science:
- Pediatric surgery
- Infectious disease epidemiology
- Health equity
Background:
- Surgical site infections (SSIs) are a major cause of morbidity in pediatric patients.
- Elevated standardized infection ratios (SIRs) for pediatric gastrointestinal (GI) procedures are a persistent concern.
- Existing SIR models, often based on adult data, may not accurately reflect pediatric-specific risks.
Purpose of the Study:
- To identify pediatric-specific risk factors for SSIs in GI surgery.
- To evaluate the applicability of adult SIR models to pediatric populations.
- To inform the development of tailored infection prevention strategies.
Main Methods:
- A case-control study involving pediatric patients (ages 0-21) undergoing GI surgery between 2019-2022.
- 82 SSI cases were matched 1:2 with 164 controls based on procedure category, year, prematurity, and age.
- Socioeconomic vulnerability was assessed using the Social Vulnerability Index (SVI); logistic regression analyses were performed.
Main Results:
- Patients with SSIs were significantly more likely to have limited English proficiency (aOR 4.26; P=.041).
- Traditional adult SIR risk factors, like diabetes, were not significant predictors in this pediatric cohort.
- SSIs were associated with longer hospitalizations (median 17.5 vs 7 days) and higher 30-day readmission rates (26% vs 10%).
Conclusions:
- Language-concordant care and addressing social vulnerabilities are crucial for preventing SSIs in pediatric GI surgery.
- Adult-based SIR models may not be suitable for pediatric populations.
- Development of pediatric-specific SIR measures is needed to ensure equitable preventive care access.
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.
