Readmission after delayed diagnosis of surgical site infection: a focus on prevention using the American College of Surgeons National Surgical Quality Improvement Program

Abstract

Background: Surgical site infection (SSI) is a costly complication leading to increased resource use and patient morbidity. We hypothesized that postdischarge SSI results in a high rate of preventable readmissions.

Methods: We used our institutional American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing general surgery procedures from 2006 to 2011.

Results: SSIs developed in 10% of the 3,663 patients who underwent an inpatient general surgical procedure. SSI was diagnosed after discharge in 48% of patients. Patients with a diagnosis of SSI after discharge were less likely to have a history of smoking (15% vs 28%, P = .001), chronic obstructive pulmonary disease (3% vs 9%, P = .015), congestive heart failure (0% vs 3%, P = .03), or sepsis within 48 hours preoperatively (17% vs 32%, P = .001) compared with patients diagnosed before discharge. Over 50% of the patients diagnosed with SSI after discharge required readmission.

Conclusions: A diagnosis of SSI after discharge is associated with a high readmission rate despite occurring in healthier patients. We propose discharge teaching improvements and a wound surveillance clinic within the first week may result in a decreased readmission rate.

Keywords: National Surgical Quality Improvement Program; Readmission; Surgical site infection.

Copyright © 2014 Elsevier Inc. All rights reserved.

Figures

Figure 1

Readmission by SSI type and table of length of time from discharge to readmission.