title: Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands.
abstract: OBJECTIVE
  To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important.
  
  
  METHODS
  Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record.
  
  
  METHODS
  Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004.
  
  
  RESULTS
  We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%).
  
  
  CONCLUSIONS
  For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Judith.Mannien@rivm.nl
authors.forename: Judith
authors.initials: J
authors.lastname: Manniën
authors.forename: Jan C
authors.initials: JC
authors.lastname: Wille
authors.forename: Ruud L M M
authors.initials: RL
authors.lastname: Snoeren
authors.forename: Susan
authors.initials: S
authors.lastname: van den Hof
mesh_terms: D019058:Community Networks; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D006761:Hospitals; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D010351:Patient Discharge; D011159:Population Surveillance / Q000379:methods*; D011182:Postoperative Care / Q000592:standards*; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control