title: 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.
authors.affiliation: Department of Surgery, University of Wisconsin, H4/3 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Gibson
authors.affiliation: Department of Surgery, University of Wisconsin, H4/3 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tevis
authors.affiliation: Department of Surgery, University of Wisconsin, H4/3 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792, USA. Electronic address: kennedyg@surgery.wisc.edu.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kennedy
mesh_terms: D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011159:Population Surveillance; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology; D014922:Wisconsin / Q000453:epidemiology
keywords: National Surgical Quality Improvement Program; Readmission; Surgical site infection