J. R. Burgess1, T. J. Novosel1, B. Knuckles1, L. D. Britt1 1Eastern Virginia Medical School,Surgery,Norfolk, VA, USA
Introduction: For many years, the rates of surgical site infections (SSIs) have been stratified according to wound classification by the Centers for Disease Control (CDC) and American College of Surgery-National Surgical Quality Improvement Program (ACS-NSQIP). However, these predicted rates are used universally for all surgical procedures and may not be applicable to the emergency surgery population. Acute care surgery (ACS) and trauma patients are at an increased risk for infection for a variety of reasons. This study was designed to determine whether the rates of surgical site infections in ACS and trauma patients are higher than the accepted standards.
Methods: A retrospective review of patients admitted to the trauma and ACS services at a level I trauma center that underwent midline laparotomy between July 2011 and June 2013 was performed. Patients were excluded if death occurred within one week of admission or if the abdomen remained open for over 72 hours. Demographic data, risk factors, ASA classification, type of surgery, wound classification, length of stay and presence of either a deep organ space infection or superficial SSI were analyzed. The rates of surgical site infections were stratified by wound classification and compared to the CDC rates of superficial SSIs and the ACS-NSQIP rates of deep organ space infections. All results noted were significant if p<0.05.
Results: During the study period there were 178 patients on the ACS service and 107 patients on the trauma service that underwent midline laparotomy and met inclusion criteria. Rates of superficial SSIs were not significantly different between historic CDC rates and our trauma patient population across all wound classes. Using the ACS-NSQIP reported data, there were significantly more deep organ space infections in contaminated wounds (27.3% vs 2.6%, p<0.05). In the ACS patient population, there were significantly more superficial SSIs in the clean/contaminated wounds (27.7% vs 11%, p<0.05) when compared to CDC rates. There were also significantly more deep space organ infections in the clean/contaminated, contaminated and dirty wounds when compared to the ACS-NSQIP data (10.8% vs 1.9%, 30% vs 2.6% and 25% vs 4.5%, respectively, p<0.05).
Conclusion: Trauma and acute care surgery patients have a significantly higher rate of deep organ space infections than the standard estimates when compared to ACS-NSQIP published data. This is likely due to the emergent nature of the cases and increased comorbidities in this patient population. Larger studies should be done to determine if this is true nationwide. If so, a different standard of surgical site infections should be adopted for these patient populations to more accurately reflect the true rate of postoperative infectious complications in these patients.