Elective Surgery Delays Raise Postop Infections


LAS VEGAS — The longer elective-surgery patients were hospitalized before their operation, the greater their risk of developing an infection postoperatively, according to a review of 163,000 patients.

Elective-admission patients hospitalized for just 1 day before their surgery had a significant 20%-50% increased risk of subsequent infection, compared with patients whose surgery took place the same day as their hospital admission, Dr. Todd R. Vogel reported at the meeting.

Patients hospitalized for 6-10 days before surgery had a greater than twofold increased risk, said Dr. Vogel, a vascular surgeon at the Robert Wood Johnson Medical School, New Brunswick, N.J.

He and his associates used data collected during 2003-2007 in the Nationwide Inpatient Sample, a database of hospital discharges in 38 states maintained by the Healthcare Cost and Utilization Project. They focused on patients aged 40 years or older who had elective admissions for any of three types of surgery: 87,318 who underwent CABG, 46,728 who had colon resection, and 28,960 who underwent lung resection. Almost a third of the patients were aged 60-69 years, nearly another third were 70-79 years old, and 20% were aged 50-59 years. Nearly two-thirds were men, and 84% were white, 6% African American, and 5% Hispanic. The analysis excluded patients who had had surgery more than 10 days after their elective hospital admission.

The infectious complications analyzed included pneumonia, urinary tract infection, sepsis, and surgical site infections.

Patients undergoing CABG had the highest rate of delays between admission and surgery, with 53% having their surgery on the same day of admission, compared with 79% of colon resection patients and 94% of lung resection patients. Another 23% of the CABG patients had a 1-day delay, 21% had a 2- to 5-day delay, and 3% had their surgery 6-10 days after admission. In the colon resection group, 13% had a 1-day delay, 7% waited 2-5 days, and 2% had a delay of 6-10 days (total is 101% because of rounding). Among those having lung resection, 3% waited 1 day, 2% waited 2-5 days, and 1% waited 6-10 days.

The postsurgical infection rate for patients who had their surgery on the day they were admitted reached 5.7% in the CABG patients, 8.4% in the lung resection patients, and 10.2% in the colon resection patients. The rates increased for each incremental delay. Among patients whose surgery was performed 6-10 days after admission, postsurgical infection rates were 18.2% for CABG, 21.6% for lung resection, and 20.6% for colon resection.

In the CABG and colon resection groups, urinary tract infection was the most common type of infection, followed by pneumonia. In the lung resection patients, pneumonia topped the infection list.

Multivariate analysis that adjusted for age, gender, race, and comorbidities showed that all three delay durations categorized in the study led to significantly greater infection rates relative to patients who had no delay in surgery, for all three operations analyzed (see chart).

Disclosures: Dr. Vogel reported no disclosures.

Infection rates were 5.7% and 18.2% for patients who had CABG the same day and 6-10 days after admission.

Source DR. VOGEL

Source Elsevier Global Medical News

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