title: Surgical site infections following ambulatory surgery procedures.
abstract: OBJECTIVE
  Surgical site infections can result in substantial morbidity following inpatient surgery. Little is known about serious infections following ambulatory surgery.
  
  
  OBJECTIVE
  To determine the incidence of clinically significant surgical site infections (CS-SSIs) following low- to moderate-risk ambulatory surgery in patients with low risk for surgical complications.
  
  
  METHODS
  Retrospective analysis of ambulatory surgical procedures complicated by CS-SSIs that require a postsurgical acute care visit (defined as subsequent hospitalization or ambulatory surgical visit for infection) using the 2010 Healthcare Cost and Utilization Project State Ambulatory Surgery and State Inpatient Databases for 8 geographically dispersed states (California, Florida, Georgia, Hawaii, Missouri, Nebraska, New York, and Tennessee) representing one-third of the US population. Index cases included 284 098 ambulatory surgical procedures (general surgery, orthopedic, neurosurgical, gynecologic, and urologic) in adult patients with low surgical risk (defined as not seen in past 30 days in acute care, length of stay less than 2 days, no other surgery on the same day, and discharged home and no infection coded on the same day).
  
  
  METHODS
  Rates of 14- and 30-day postsurgical acute care visits for CS-SSIs following ambulatory surgery.
  
  
  RESULTS
  Postsurgical acute care visits for CS-SSIs occurred in 3.09 (95% CI, 2.89-3.30) per 1000 ambulatory surgical procedures at 14 days and 4.84 (95% CI, 4.59-5.10) per 1000 at 30 days. Two-thirds (63.7%) of all visits for CS-SSI occurred within 14 days of the surgery; of those visits, 93.2% (95% CI, 91.3%-94.7%) involved treatment in the inpatient setting. All-cause inpatient or outpatient postsurgical visits, including those for CS-SSIs, following ambulatory surgery occurred in 19.99 (95% CI, 19.48-20.51) per 1000 ambulatory surgical procedures at 14 days and 33.62 (95% CI, 32.96-34.29) per 1000 at 30 days.
  
  
  CONCLUSIONS
  Among patients in 8 states undergoing ambulatory surgery, rates of postsurgical visits for CS-SSIs were low relative to all causes; however, they may represent a substantial number of adverse outcomes in aggregate. Thus, these serious infections merit quality improvement efforts to minimize their occurrence.
authors.affiliation: Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Owens
authors.affiliation: M. L. Barrett Inc, Del Mar, California.
authors.forename: Marguerite L
authors.initials: ML
authors.lastname: Barrett
authors.affiliation: Truven Health Analytics, Bethesda, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Raetzman
authors.affiliation: RAND Corporation, Los Angeles, California5Department of Surgery, University of California at Los Angeles.
authors.forename: Melinda
authors.initials: M
authors.lastname: Maggard-Gibbons
authors.affiliation: Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland.
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Steiner
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000556:Ambulatory Surgical Procedures; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology