Safety improvements can fight infections

Although the rates of serious surgical site infections (SSIs) following outpatient surgery are low, the number of patients who develop these serious infections is substantial and warrants continued quality improvement efforts because outpatient surgery is so common, according to a new study published in the Journal of the American Medical Association and funded by the Agency for Healthcare Research and Quality (AHRQ).

Nearly two-thirds of all surgeries in the US are performed in ambulatory (also known as outpatient) settings that do not include overnight hospital stays. Ambulatory surgeries are usually low- to moderate-risk procedures that are performed on patients who are at lower risk for complications.

In the study, "Surgical Site Infections Following Ambulatory Procedures," researchers used AHRQ's Healthcare Cost and Utilization Project databases to analyze SSI rates following surgery in hospital-owned ambulatory (outpatient) settings in eight states.

SSIs are among the most common type of healthcare-associated infection (HAI). The authors found that 877 patients in the eight states, or a rate of just over 3 (3.09) of every 1,000 patients, who had ambulatory surgery were treated within 14 days for a SSI that required hospitalization. At 30 days, the rate increased to nearly 5 (4.84) of every 1,000 patients.

"Healthcare-associated infections remain a common complication of care following ambulatory surgery," said AHRQ director Dr Richard Kronick. "The number of patients experiencing these serious infections is an important consideration, and work should continue to make outpatient surgery safer."

Researchers led by Dr Pamela Owens and Dr Claudia Steiner, both of AHRQ, analyzed records of nearly 285,000 ambulatory surgeries that were followed by a serious SSI requiring a hospital stay or an ambulatory surgery visit in adult, low surgical risk patients.

Because the study found that most of the serious SSIs occur within 14 days, the study's authors recommended that more attention be paid to preventing and reducing infections in the early window following an ambulatory surgery. For example, routine clinical follow-up within 14 days following an ambulatory surgery may help detect infections earlier before they become serious and require hospitalization.

To date, much of the focus on preventing SSIs and other HAIs has been placed on surgeries that occur during inpatient stays. The study's authors said that the findings from this research reaffirm that HAIs can also occur following outpatient surgeries and that quality improvement programs should also be targeted to prevent infections following ambulatory surgery.