The impact of post discharge surveillance infections on colorectal procedures among VINCat hospitals

Background: Surgical site infections (SSI) are preventable costly complications and represent a measurable quality of care. There is an increasing interest to compare SSI rates between surgeons, institutions and countries. However the conflicting data regarding the incidence of SSI are a cause of concern. For comparison purposes, data must be standardized and must include strict post discharge surveillance (PDS).

Objective: to determine the impact of PDS among rates of SSI on colorectal elective procedures.

Methods: VINCat is a nosocomial infection surveillance program in Catalonia (6.5 million population), Spain. Beginning 2007, 45 hospitals perform prospective standardized surveillance (continuous surveillance or at least 100 annual procedures per hospital) for elective colon resection (COLO). Mandatory PDS of 30 days follow-up was implemented by: a) electronic review of clinical charts, b) readmissions, c) emergency visits, d) microbiological and radiological data and e) telephone call.

Results: During the years 2007 and 2008, 4,732 elective colorectal procedures were performed. Mean age 69y (±12y), 58% males.  Risk Index categories were: (M/O):2.291 pts, (1):1.833 pts, (2-3): 608 pts.  Among them 943 (19.9%) pts developed SSI, 198 (21%) of them after discharge. Among patients with COLO/PDS infections, 96/198 (48%) were deep incisional or organ/space infections..

Conclusions: the incidence of SSI was substantially higher than other reported in the literature, partially caused for deep incisional and organ/space infections reported during PDS. Multimodal approach for detecting post discharge infections should be implemented