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Outpatient Surgery: Is Infection A Real Risk?

Wed, 02/19/2014 - 7:22am
Michael Smith

The chance of a clinically significant infection after ambulatory surgery is relatively small; nonetheless, outpatient surgery related infections account for roughly one in five healthcare-associated infections.

That seeming contradiction is explained by the fact that ambulatory surgery accounts for more than 63 percent of all operations in the U.S., so the absolute number of affected patients is large, according to Claudia Steiner, MD, of the Agency for Healthcare Research and Quality in Rockville, Md., and colleagues.

"These serious infections merit quality improvement efforts to minimize their occurrence," Steiner and colleagues argued in the Feb. 19 issue of the Journal of the American Medical Association.

In the inpatient setting, surgical site infections are known to be an important problem, Steiner and colleagues noted, accounting for between 20 percent and 31 percent of healthcare-associated infections.

But there is a "dearth of information" on adverse events after ambulatory surgery, including clinically significant infections, they noted.

To help fill the gap, Steiner and colleagues used the 2010 Healthcare Cost and Utilization Project State Ambulatory Surgery and State Inpatient Databases for eight geographically dispersed states -- California, Florida, Georgia. Hawaii, Missouri, Nebraska, New York, and Tennessee -- which together represent a third of the U.S. population.

The analysis included outcomes from 284,098 adult patients who underwent one of 12 common procedures from several surgical areas -- general orthopedic, neurosurgical, gynecologic, and urologic surgery.

Steiner and colleagues calculated the rate of 14- and 30-day post-surgical acute care visits for surgical site infections following the procedure, as well as for all-cause visits at the same times.

They found:

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