Key result
Repetitive and multiple surgeries significantly increased the risk of surgical site infections (OR 2.39 and 1.27, respectively), whereas prior surgery did not.
Why the study?
Do prior, multiple-, or repetitive surgeries increase the risk of surgical site infections in patients undergoing common surgical procedures?
Cohort (n=115,943)
Yes
Do prior, multiple-, or repetitive surgeries increase the risk of surgical site infections in patients undergoing common surgical procedures?
Effect estimate: OR 2.39 (95% CI 2.06-2.77)
Absolute Event Rate: 7.8% vs 2.4%
Multiple and repetitive surgeries, but not prior surgeries, are significant risk factors for surgical site infections, suggesting surveillance protocols can be simplified by omitting prior surgery data.
Multiple/repetitive surgeries associated with higher SSI risk, unlike prior surgery; leaves open whether surveillance protocols can omit prior surgery data.
OBJECTIVE Surveillance is an important strategy to reduce the incidence of surgical site infections (SSIs). We investigated whether prior, multiple-, or repetitive surgeries are risk factors for SSI and whether they should be preserved in the protocol of the Dutch national SSI surveillance network. METHODS Dutch national SSI surveillance data 2012-2015 were selected, including 34 commonly performed procedures from 8 major surgical specialties. Definitions of SSIs followed international standardized criteria. We used multivariable multilevel logistic regression techniques to evaluate whether prior, multiple-, or repetitive procedure(s) are risk factors for SSIs. We considered surgeries clustered within partnerships of medical specialists and within hospitals (random effects) and different baseline risks between surgical specialties (fixed effects). Several patient and surgical characteristics were considered possible confounders and were included where necessary. We performed analyses for superficial and deep SSIs combined as well as separately. RESULTS In total, 115,943 surgeries were reported by 85 hospitals; among them, 2,960 (2.6%) resulted in SSIs (49.3% deep SSIs). The odds ratio (OR) for having prior surgery was 0.94 (95% confidence interval [CI], 0.74-1.20); the OR for repetitive surgery was 2.39 (95% CI, 2.06-2.77); and the OR for multiple surgeries was1.27 (95% CI, 1.07-1.51). The latter effect was mainly caused by prolonged duration of surgery. CONCLUSIONS Multiple- and repetitive surgeries significantly increased the risk of an SSI, whereas prior surgery did not. Therefore, prior surgery is not an essential data item to include in the national SSI surveillance network. The increased risk of SSIs for multiple surgeries was mainly caused by prolonged duration of surgery, therefore, it may be sufficient to report only duration of surgery to the surveillance network, instead of both (the variables duration of surgery and multiple surgeries). Infect Control Hosp Epidemiol 2017;38:1298-1305.
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Verberk et al. (2017) conducted a cohort in Surgical site infections (n=115,943). Repetitive surgery vs. No repetitive surgery was evaluated on Cumulative incidence of surgical site infections (OR 2.39, 95% CI 2.06-2.77). Repetitive and multiple surgeries significantly increased the risk of surgical site infections (OR 2.39 and 1.27, respectively), whereas prior surgery did not.