A team from the Department of Orthopaedic Surgery at Washington University in St. Louis in Missouri has reviewed 6.5 years’ worth of data from patients who’d received orthopedic surgery at an ambulatory surgical center (ASC). The Wash U team looked at patient and surgical risk factors associated with surgical site infections (SSI). The results? the researchers found that the incidence of SSIs was 0.32%—and that five factors can push that risk higher.
ASC Surgical Site Infections – How Big Is the Risk?
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Their work, “Risk Factors for Surgical Site Infections After Orthopaedic Surgery in the Ambulatory Surgical Center Setting,” appears in the October 15, 2019 edition of the Journal of the American Academy of Orthopaedic Surgeons.
Co-author Robert Brophy, M.D., professor in the Department of Orthopaedic Surgery at Washington University explained the thinking behind the study to OTW, “Infections are low in the ambulatory surgical center setting but still problematic and we wanted to identify any modifiable risk factors.”
Using a stepwise multivariate logistic regression to determine the risk factors for surgical site infections, the researchers found that the incidence of surgical site infections was 0.32%. They determined that five independent factors were associated with surgical site infections: anatomic area, anesthesia type, patient’s age at surgery, diabetes mellitus, and tourniquet time.
Dr. Brophy told OTW, “Infection rates vary by anatomic surgical site (lowest in the shoulder, highest in the hip), age (elevated risk in patients over the age of 70), and type of anesthesia (elevated in combined regional and general compared to general in isolation). Patients with diabetes also have a higher risk of infection.”
He suggests that physicians pay close attention to patients who, based on anatomic site of surgery, age, anesthesia and diabetes, require additional patient counseling and postoperative surveillance in order to minimize the risk of surgical site infections.
“Infection risk is low in the ambulatory surgical center setting but physicians should understand the factors associated with a higher risk of infection in this setting.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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