Help reduce readmissions resulting from surgical site complications

Patients who develop a surgical site infection are approximately three times more likely to be readmitted to hospital, increasing 

the cost of inpatient stay(1)

 

Surgical site complications, including infection and wound dehiscence, are frequent adverse outcomes of surgical procedures. The latest point prevalence study of hospital-acquired infections (HAI) from the European Centre for Disease Control (ECDC) captured data from 881 hospitals across 30 countries and a population of over 200,000 patients.(2) This study identified that surgical site infections (SSIs) were the most frequent cause of HAI, accounting for almost 20% of all infections detected. The overall rate of surgical site infections was around 1.3% across all hospitalised patients although it should be noted that only around 27% of patients in the survey had undergone a surgical procedure. 

 

A growing problem associated with monitoring surgical site complications is the fact that as hospital stays become shorter, a greater proportion of infections occur post-discharge. The ECDC point prevalence study suggests that the median time to onset is 8–14 days, meaning that hospital-based surveillance systems provide only a partial picture of the true burden of surgical site complications.

 

To highlight this, a recent study by the Health Protection Agency in England(3) examined rates of infection within 30 days of a caesarean section and found an infection rate of almost 10%, significantly greater than previously reported hospital based surveillance studies. Of note, women with a BMI >35 were 3.7-times more likely to experience an infection than women of normal weight, while women with diabetes were almost twice as likely to develop an infection compared to women without diabetes. 

 

Readmission is one of the consequences of patients contracting an HAI. In the recent report, surveillance of surgical site infections in NHS hospitals in England 2010/2011,(4) 28% of the total number of identified SSIs were the result of a readmission.

 

The same report highlighted a three-fold increase in volume of operations between April 2004 and March 2011. As the number of procedures increases, the result of a population of increasing age and comorbidities, such as diabetes and obesity, the demand for beds is ever increasing.

 

A raft of best practice guidelines have been made available with the intention of reducing the risk of surgical site complications. Many of these highlight the need for pre-operative and intra-operative risk management, such as the use of prophylactic antibiotics and skin preparation; however, there is relatively little guidance on post-operative management of the surgical site.(5) 

 

There are innovative post-operative solutions available which have been shown to help reduce complications such as infection. A Single Use Negative Pressure Wound Therapy System has been shown to help reduce length of stay in high risk patients(6) and reduce the number of readmissions compared to the standard of care.(7) These combined factors can help free up bed days and mitigate patient waiting lists.

 

Healthcare decision makers are encouraged to consider the importance of post-operative steps designed to reduce the risk of surgical site complications and the contribution of technology, such as Single Use Negative Pressure Wound Therapy.

 

References

1. Jenks PJ et al. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequence of elimination of SSI from an English hospital. J Hosp Infect 2014;86:24–33.
2. European Centre for Disease Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2011–2012. Stockholm, ECDC;2013. 
3. Wloch C et al. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG 2013;DOI: 10.1111/j.1471-0528.2012.03452.x
4. Health Protection Agency. Surveillance of surgical site infections in HHS hospitals in England 2010/2011. London: December 2011.
5. NICE. Clinical Guideline 74. Surgical site infection. Prevention and treatment of surgical site infection. National Institute for Health and Care Excellence, London; 2008. 
6. Pellino G et al. Effects of a new pocket device for negative pressure wound therapy on surgical wounds of patients affected by Crohns disease: A pilot trial Surg Innov;DOI: 10.1177/1553350613496906.
7. Bullough L, Wilkinson D. Changing woundcare protocols to reduce post-operative complications. Poster presented. Wounds UK, Harrogate 2012.

References available on request.