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Surgical Site Infection Rates: Good or Bad?

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Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 8600 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 8600 followers on Twitter.

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Postoperative acute care visits for clinically significant surgical site infections (SSIs) occurred within 14 days after 3.09 of every 1,000 ambulatory operations performed and within 30 days in 4.84 of every 1000 operations, according to a study, published in a recent issue of JAMA. The study involved 282,086 selected ambulatory surgical procedures that took place in eight states, comprising about one-third of the population of the United States in 2010.

A clinically significant infection was defined as one that resulted in at least one subsequent ambulatory surgery visit or inpatient stay within 14 or 30 days. Visits to doctors offices and those sent home from emergency departments were not included.

The operations included clean cases, such as anterior cruciate ligament repairs, spine surgery, various hernia repairs, and so-called clean-contaminated cases like laparoscopic cholecystectomy and hysterectomy.

The authors acknowledged that the rates of clinically SSI were relatively low but were concerned that the number of infections collectively was substantial. They suggested that unspecified quality improvement efforts to prevent infections should be considered.

When I first read this paper’s abstract, I was struck by just how low the rate of serious infections was, and the feeling was reinforced after reading the full text of the paper.

If you look at the numbers more closely, you will find that of the 12 types of procedures investigated, there were only 867 infections within 14 days and 1,276 within 30 days. In other words, those are percentages of 0.3% and 0.48%, respectively.

For comparison, a recent paper in the Journal of Surgical Research by surgeons from Johns Hopkins found that in over 600,000 operations, the rates of infection were 1.76% for clean and 3.94% for clean-contaminated cases.

As a surgeon, I realize I am biased, but really, 0.3% and 0.48% don’t look like very bad rates of infection. This is especially true when you consider that if this represents one-third of the U.S. population and you could extrapolate that for the 12 operations, there were only 2,601 infections within 14 days and 3,828 within 30 days for the entire country. Those numbers don’t seem that substantial to me.

An infection is substantial and personal for the patient, and I am all for trying our best to prevent SSIs. But as I have said before, some are simply not preventable, which I know is disappointing to those who believe that all complications and infections are due to medical errors.

Rather than worry about these results, we should take comfort in them.

Something is going right.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 8600 followers on Twitter.

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