APSA PaperSurgical site infection reporting: more than meets the agar

Background/purposeSurgical site infection (SSI) rate in pediatric appendicitis is a commonly used hospital quality metric. We hypothesized that surveillance of organ-space SSI (OSI) using cultures alone would fail to capture many clinically-important events.MethodsA prospective, multidisciplinary surveillance program recorded 30-day SSI and hospital length of stay (LOS) for patients < 18 years undergoing appendectomy for perforated appendicitis from 2012 to 2015. Standardized treatment pathways were utilized, and OSI was identified by imaging and/or bacterial cultures.ResultsFour hundred ten appendectomies for perforated appendicitis were performed, and a total of 84 OSIs (20.5%) were diagnosed with imaging. Positive cultures were obtained for 39 (46%) OSIs, whereas 45 (54%) had imaging only. Compared to the mean LOS for patients without OSI (5.2 ± 2.9 days), LOS for patients with OSI and positive cultures (13.7 ± 5.4 days) or with OSI without cultures (10.4 ± 3.7 days) was significantly longer (both p < 0.001). The OSI rate identified by positive cultures alone was 9.5%, whereas the clinically-relevant OSI rate was 20.5%.ConclusionsUsing positive cultures alone to capture OSI would have identified less than half of clinically-important infections. Utilizing clinically-relevant SSI is an appropriate metric for comparing hospital quality but requires agreed upon standards for diagnosis and reporting.Level of evidenceII.Type of studyDiagnostic study.