TY - JOUR
T1 - Incidence and Relative Burden of Surgical Site Infections in Children Undergoing Nonemergent Surgery
T2 - Implications for Performance Benchmarking and Prioritization of Prevention Efforts
AU - He, Katherine
AU - Iwaniuk, Marie
AU - Goretsky, Michael J.
AU - Cina, Robert A.
AU - Saito, Jacqueline M.
AU - Hall, Bruce
AU - Grant, Catherine
AU - Cohen, Mark E.
AU - Newland, Jason
AU - Hall, Matthew
AU - Ko, Clifford Y.
AU - Rangel, Shawn J.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Objective: To establish surgical site infection (SSI) performance benchmarks in pediatric surgery and to develop a prioritization framework for SSI prevention based on procedure-level SSI burden. Background: Contemporary epidemiology of SSI rates and event burden in elective pediatric surgery remain poorly characterized. Methods: Multicenter analysis using sampled SSI data from 90 hospitals participating in NSQIP-Pediatric and procedural volume data from the Pediatric Health Information System (PHIS) database. Procedure-level incisional and organ space SSI (OSI) rates for 17 elective procedure groups were calculated from NSQIP-Pediatric data and estimates of procedure-level SSI burden were extrapolated using procedural volume data. The relative contribution of each procedure to the cumulative sum of SSI events from all procedures was used as a prioritization framework. Results: A total of 11,689 nonemergent procedures were included. The highest incisional SSI rates were associated with gastrostomy closure (4.1%), small bowel procedures (4.0%), and gastrostomy (3.7%), while the highest OSI rates were associated with esophageal atresia/tracheoesophageal fistula repair (8.1%), colorectal procedures (1.8%), and small bowel procedures (1.5%). 66.1% of the cumulative incisional SSI burden from all procedures were attributable to 3 procedure groups (gastrostomy: 27.5%, small bowel: 22.9%, colorectal: 15.7%), and 72.8% of all OSI events were similarly attributable to 3 procedure groups (small bowel: 28.5%, colorectal: 26.0%, esophageal atresia/tracheoesophageal fistula repair: 18.4%). Conclusions: A small number of procedures account for a disproportionate burden of SSIs in pediatric surgery. The results of this analysis can be used as a prioritization framework for refocusing SSI prevention efforts where they are needed most.
AB - Objective: To establish surgical site infection (SSI) performance benchmarks in pediatric surgery and to develop a prioritization framework for SSI prevention based on procedure-level SSI burden. Background: Contemporary epidemiology of SSI rates and event burden in elective pediatric surgery remain poorly characterized. Methods: Multicenter analysis using sampled SSI data from 90 hospitals participating in NSQIP-Pediatric and procedural volume data from the Pediatric Health Information System (PHIS) database. Procedure-level incisional and organ space SSI (OSI) rates for 17 elective procedure groups were calculated from NSQIP-Pediatric data and estimates of procedure-level SSI burden were extrapolated using procedural volume data. The relative contribution of each procedure to the cumulative sum of SSI events from all procedures was used as a prioritization framework. Results: A total of 11,689 nonemergent procedures were included. The highest incisional SSI rates were associated with gastrostomy closure (4.1%), small bowel procedures (4.0%), and gastrostomy (3.7%), while the highest OSI rates were associated with esophageal atresia/tracheoesophageal fistula repair (8.1%), colorectal procedures (1.8%), and small bowel procedures (1.5%). 66.1% of the cumulative incisional SSI burden from all procedures were attributable to 3 procedure groups (gastrostomy: 27.5%, small bowel: 22.9%, colorectal: 15.7%), and 72.8% of all OSI events were similarly attributable to 3 procedure groups (small bowel: 28.5%, colorectal: 26.0%, esophageal atresia/tracheoesophageal fistula repair: 18.4%). Conclusions: A small number of procedures account for a disproportionate burden of SSIs in pediatric surgery. The results of this analysis can be used as a prioritization framework for refocusing SSI prevention efforts where they are needed most.
KW - antibiotic stewardship
KW - pediatric surgery
KW - surgical site infection
UR - http://www.scopus.com/inward/record.url?scp=85150360689&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005673
DO - 10.1097/SLA.0000000000005673
M3 - Article
C2 - 35943207
AN - SCOPUS:85150360689
SN - 0003-4932
VL - 278
SP - 280
EP - 287
JO - Annals of surgery
JF - Annals of surgery
IS - 2
ER -