Predictive factors of post-discharge surgical site
                    infections among patients from a teaching hospital

Gomes, Adriana Estela Biasotti; Cavalcante, Ricardo de Souza; Pavan, Érika Cibele Pereira; Freitas, Elaine da Silva; Fortaleza, Carlos Magno Castelo Branco

doi:10.1590/0037-8682-0069-2013

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Sumário

Short Communications • Rev. Soc. Bras. Med. Trop. 47 (02) • 20 May 2014 • https://doi.org/10.1590/0037-8682-0069-2013 copy

Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction

Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance.

Methods

We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge.

Results

Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay.

Conclusions

Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance.

Infection control; Surgical site infections; Surveillance

Specialty	Surgical procedures	Total SSI cases	PD-SSI cases	SSI rate (%)	Proportion of PD-SSI (%)
General surgery	307	9	7	2.9	77.8
Gastric/intestinal surgery	1,106	91	55	8.2	60.4
Neurological surgery	474	23	5	4.9	21.7
Vascular surgery	294	24	13	8.2	54.2
Gynecology	617	42	38	6.8	90.5
Obstetrics	678	33	20	4.9	60.6
Total	3,476	222	138	6.4	62.2

Predictors	Univariate analysis				Multivariable analysis
Predictors	PD-SSI (138)	Other SSI^a a all SSIs with onset during admission; (84)	OR (95%CI)	P	OR (95%CI)	P
Demographic data
male gender	43 (31.2)	38 (45.2)	0.55 (0.31-0.96)	0.03	0.81 (0.38-1.70)	0.57
age - median years (range)	48 (1-87)	48 (0-86)	…^b b in the univariate analysis, age was compared for the study groups using the Mann-Whitney U test. In the multivariable analysis, age was included in the models as a continuous variable, and thus the OR represents the increase in the odds of post-discharge diagnosis per increase in age unit;	0.5	1.01 (0.99-1.03)^b b in the univariate analysis, age was compared for the study groups using the Mann-Whitney U test. In the multivariable analysis, age was included in the models as a continuous variable, and thus the OR represents the increase in the odds of post-discharge diagnosis per increase in age unit;	0.58
Specialty
neurological surgery - reference	5 (3.6)	18 (21.5)	1.0	…^c c all the classes are compared with the reference. The OR for the reference category in the logistic regression refers to the difference between this category and all the others grouped;	1.0	0.03c
general surgery	7 (5.1)	2 (2.4)	12.6 (1.97-80.76)	0.007	10.11 (1.13-90.13)	0.04
gastric/intestinal surgery	55 (39.9)	36 (42.9)	5.50 (1.88-16.13)	0.002	3.52 (0.93-13.35)	0.06
vascular surgery	13 (9.4)	11 (13.1)	4.25 (1.18-15.24)	0.03	3.09 (0.63-15.18)	0.16
gynecology	38 (27.5)	4 (4.8)	34.20 (8.19-142.82)	<0.01	15.18 (2.94-78.45)	<0.01
obstetrics	20 (14.5)	13 (15.4)	5.54 (1.65-18.63)	<0.01	3.61 (0.83-15.80)	0.09
Wound classification
clean - reference	20 (14.5)	13 (15.5)	1.0	…^c c all the classes are compared with the reference. The OR for the reference category in the logistic regression refers to the difference between this category and all the others grouped;	1.0	0.08c
clean/contaminated	89 (64.5)	46 (54.8)	1.26 (0.57-2.75)	0.57	0.87 (0.32-2.35)	0.78
contaminated	15 (10.9)	18 (21.4)	0.54 (0.20-1.44)	0.37	0.33 (0.11-1.21)	0.1
dirty	14 (10.1)	7 (8.3)	1.30 (0.41-4.08)	0.65	1.81 (0.42-7.87)	0.42
Other characteristics of the procedures
urgency/emergency	49 (35.5)	44 (52.2)	0.50 (0.29-0.87)	0.01	0.65 (0.31-1.34)	0.24
more than one surgery simultaneously	4 (2.9)	8 (9.5)	0.29 (0.08-0.97)	0.04
blood transfusion	24 (17.4)	30 (35.7)	0.38 (0.20-0.70)	<0.01	0.70 (0.32-1.51)	0.36
Patients' comorbidities
heart disease	2 (1.4)	2 (2.4)	0.60 (0.04-8.48)	0.48
systemic arterial hypertension	59 (42.8)	25 (41.7)	1.05 (0.60-1.81)	0.87
lung disease	4 (2.9)	2 (2.4)	1.22 (0.17-13.79)	0.59
renal disease	5 (3.6)	2 (2.4)	1.54 (0.24-16.50)	0.46
liver disease	0 (0.0)	2 (2.4)	0.0 (…^d d OR and CI could not be calculated as one of the categories had zero value; )	0.14
diabetes mellitus	31 (22.5)	14 (16.7)	1.45 (0.72-2.91)	0.29
central nervous systems disease	7 (5.1)	10 (11.9)	0.39 (0.14-1.05)	0.06	0.52 (0.14-1.87)	0.31
solid malignancy	25 (18.1)	16 (19.0)	0.94 (0.47-1.88)	0.86
malnourishment^e e reported in medical files.	5 (3.6)	0 (0.0)	…^d d OR and CI could not be calculated as one of the categories had zero value;	0.09
obesity	28 (20.2)	15 (17.9)	1.17 (0.58-2.35)	0.65
Other characteristics of the patients
use of steroids during admission	2 (1.4)	13 (15.5)	0.08 (0.02-0.37)	< 0.001	0.11 (0.02-0.59)	0.01
smoking	48 (34.8)	31 (36.9)	0.91 (0.51-1.60)	0.75
alcoholism^e e reported in medical files.	7 (5.1)	10 (11.7)	0.39 (0.04-1.08)	0.06

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[1] Dr^a Adriana Estela Biasotti Gomes. Comissão de Controle de Infecção Relacionada à Assistência em Saúde/HC/FMB/UNESP. Distrito de Rubião Junior s/n, 18618-970 Botucatu, SP, Brasil. Phone: 55 14 3811-6037; Fax: 55 14 3815-9898, e-mail: adriana.ciras@gmail.com