2132. Infections after Pediatric Ambulatory Surgery: Incidence and Risk Factors
Session: Poster Abstract Session: Healthcare Epidemiology: Surgical Site Infections
Saturday, October 6, 2018
Room: S Poster Hall
Background:

Approximately 3 million pediatric ambulatory surgical procedures are performed each year in the US; however, little is known about the incidence of and risk factors for surgical site infections (SSI) after pediatric surgical procedures performed in these settings. Therefore, we aimed to describe the epidemiology of SSI in children after ambulatory surgery.

Methods:

We conducted a prospective, observational study in a single healthcare network with 3 ambulatory surgical facilities (ASF) and 1 hospital-based facility. We enrolled children <18 years who had an ambulatory surgical procedure between June 2012 and December 2015. Data on follow-up care were collected via a structured telephone interview (30-45 days post-surgery) and review of the electronic health record (EHR) 60 days post-surgery. We identified SSIs 30 days after surgery by applying 2010 National Healthcare Safety Network (NHSN) definitions. We also developed a broader definition of possible infectious events associated with surgery up to 60 days after surgery.

Results:

We enrolled 8502 surgical encounters; 64% occurred at the hospital-based facility. Three procedure categories (soft tissue excision, hernia, scrotal/testicular) accounted for 56% of encounters at ASFs. We identified 21 NHSN defined SSIs (2.5 SSIs per 1000 surgical encounters). In adjusted analysis, there was no difference between hospital-based facility and ASF SSI rates (OR 0.7; 95% CI 0.2 – 2.3). Using the broader definition, we identified 404 surgical encounters with strong or some evidence of possible infection (48 per 1000 surgical encounters). There was poor agreement of possible infections identified via parent interview vs. EHR. In multivariable analysis using the broader definition, older age and black race were associated with a reduced risk.

Conclusion:

Using a rigorous surveillance definition, the incidence of surgical site infections was low after pediatric ambulatory surgery although our data suggest there may be additional infectious complications that are not captured by the NHSN definition. Given the annual rate of pediatric ambulatory surgery, even a low rate of infection may result in a significant medical burden.

Jeffrey S. Gerber, MD, PhD1, Rachael Ross, MPH1, Rui Xiao, PhD2, A.Russell Localio, PhD3, Robert Grundmeier, MD4, Susan Rettig, BSN, CIC5, Eva Teszner, RN, CIC5, Julia E. Szymczak, PhD6, Douglas Canning, MD7 and Susan E. Coffin, MD, MPH, FSHEA, FPIDS8, (1)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (3)University of Pennsylvania, Philadelphia, PA, (4)General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA, (6)Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, (7)Children's Hospital of Philadelphia, Philadelphia, PA, (8)Center for Pediatric Clinical Effectiveness, Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children's Hospital of Philadelphia, Philadelphia, PA

Disclosures:

J. S. Gerber, None

R. Ross, None

R. Xiao, None

A. R. Localio, None

R. Grundmeier, None

S. Rettig, None

E. Teszner, None

J. E. Szymczak, None

D. Canning, None

S. E. Coffin, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.