title: Post-discharge surgical site infections after uncomplicated elective colorectal surgery: impact and risk factors. The experience of the VINCat Program.
abstract: BACKGROUND
  Surgical site infection (SSI) after colorectal procedures represents a measurable quality indicator of a healthcare system. There is an increasing interest in comparing SSI rates between different hospitals and countries: however, the variability of the data regarding the incidence of SSI makes this comparison difficult. For the purposes of evaluation, data collection must be standardized and must include reliable post-discharge surveillance (PDS).
  
  
  OBJECTIVE
  To determine impact and risk factors for PDS SSI after elective colorectal surgery.
  
  
  METHODS
  VINCat is a nosocomial infection surveillance programme in Catalonia, Spain. Between 2007 and 2011, 52 hospitals joined the programme. Hospitals performed active, prospective, standardized surveillance of elective colorectal resection. PDS was implemented by a multimodal approach and was mandatory within the first 30 days after surgery.
  
  
  RESULTS
  During the study period, 13,661 elective colorectal procedures were included. SSI was diagnosed in 2826 (20.7%) patients, of whom 22.5% during PDS; of these, 52% required readmission. Patients with PDS SSI were younger (odds ratio: 1.57; 95% confidence interval: 1.29-1.91), predominantly female (1.40; 1.16-1.69), had more frequently undergone endoscopic procedures (1.56; 1.30-1.88) and had more incisional SSI (1.88; 1.54-2.28) than patients with in-hospital SSI.
  
  
  CONCLUSIONS
  SSI rates in elective colorectal procedures at VINCat hospitals were inside the higher range of those reported by other national programmes. PDS SSI increased the overall rate of SSI, had a significant clinical impact, and accounted for almost a quarter of SSI. Younger age and laparoscopic procedures were the most relevant risk factors. Standardized multimodal PDS should be implemented for hospitals performing surveillance of colorectal surgery.
authors.affiliation: VINCat Coordinator Center, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Limón
authors.affiliation: Hospital Universitari de Bellvitge, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Shaw
authors.affiliation: Hospital General de Granollers, Granollers, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Badia
authors.affiliation: Corporació Sanitària Parc Taulí, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Piriz
authors.affiliation: Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Escofet
authors.affiliation: VINCat Coordinator Center, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
authors.affiliation: VINCat Coordinator Center, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: mpujol@bellvitgehospital.cat.
authors.forename: M
authors.initials: M
authors.lastname: Pujol
mesh_terms: D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology*
keywords: Colon surgery; Post-discharge infections; Risk factors; Surgical site infections; Surveillance