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Original Investigation |

Surgical Site Infections Following Ambulatory Surgery Procedures

Pamela L. Owens, PhD1; Marguerite L. Barrett, MS2; Susan Raetzman, MSPH3; Melinda Maggard-Gibbons, MD, MSHS4,5; Claudia A. Steiner, MD, MPH1
[+] Author Affiliations
1Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland
2M. L. Barrett Inc, Del Mar, California
3Truven Health Analytics, Bethesda, Maryland
4RAND Corporation, Los Angeles, California
5Department of Surgery, University of California at Los Angeles
JAMA. 2014;311(7):709-716. doi:10.1001/jama.2014.4.
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Published online

Importance  Surgical site infections can result in substantial morbidity following inpatient surgery. Little is known about serious infections following ambulatory surgery.

Objective  To determine the incidence of clinically significant surgical site infections (CS-SSIs) following low- to moderate-risk ambulatory surgery in patients with low risk for surgical complications.

Design, Setting, and Participants  Retrospective analysis of ambulatory surgical procedures complicated by CS-SSIs that require a postsurgical acute care visit (defined as subsequent hospitalization or ambulatory surgical visit for infection) using the 2010 Healthcare Cost and Utilization Project State Ambulatory Surgery and State Inpatient Databases for 8 geographically dispersed states (California, Florida, Georgia, Hawaii, Missouri, Nebraska, New York, and Tennessee) representing one-third of the US population. Index cases included 284 098 ambulatory surgical procedures (general surgery, orthopedic, neurosurgical, gynecologic, and urologic) in adult patients with low surgical risk (defined as not seen in past 30 days in acute care, length of stay less than 2 days, no other surgery on the same day, and discharged home and no infection coded on the same day).

Main Outcomes and Measures  Rates of 14- and 30-day postsurgical acute care visits for CS-SSIs following ambulatory surgery.

Results  Postsurgical acute care visits for CS-SSIs occurred in 3.09 (95% CI, 2.89-3.30) per 1000 ambulatory surgical procedures at 14 days and 4.84 (95% CI, 4.59-5.10) per 1000 at 30 days. Two-thirds (63.7%) of all visits for CS-SSI occurred within 14 days of the surgery; of those visits, 93.2% (95% CI, 91.3%-94.7%) involved treatment in the inpatient setting. All-cause inpatient or outpatient postsurgical visits, including those for CS-SSIs, following ambulatory surgery occurred in 19.99 (95% CI, 19.48-20.51) per 1000 ambulatory surgical procedures at 14 days and 33.62 (95% CI, 32.96-34.29) per 1000 at 30 days.

Conclusions and Relevance  Among patients in 8 states undergoing ambulatory surgery, rates of postsurgical visits for CS-SSIs were low relative to all causes; however, they may represent a substantial number of adverse outcomes in aggregate. Thus, these serious infections merit quality improvement efforts to minimize their occurrence.

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Figure.
Ambulatory Surgical Procedures Meeting Study Criteriaa

aSource: Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project; State Ambulatory Surgery Databases and State Inpatient Databases for 8 states: California, Florida, Georgia, Hawaii, Missouri, Nebraska, New York, and Tennessee, 2010.bPatients total 282 086; some patients underwent more than 1 ambulatory surgical procedure that met all of the study criteria.

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