title: Surgical site infection in hand surgery.
abstract: OBJECTIVE
  As ambulatory surgery becomes increasingly common, there is growing interest in assessing, monitoring, and tracking complications that occur secondary to outpatient procedures. We sought to determine the rates of 14- and 30-day acute care visits for surgical site infection after outpatient hand surgery, and to identify associated factors.
  
  
  METHODS
  Using the California State Ambulatory Surgery database for 2010 and 2011, we identified 44,305 patients undergoing common outpatient hand surgery procedures. Cases were linked to the State Emergency Department and the State Inpatient databases for postoperative acute care visits (e.g. hospitalizations, emergency department or ambulatory surgical visits) related to surgical site infection.
  
  
  RESULTS
  Postoperative acute care visits for surgical site infection occurred in 1.7 per 1,000 hand surgery procedures (0.17 %) at 14 days, and 3.3 per 1,000 (0.33 %) at 30 days. Thirty-day infection rates were lowest after ganglion cyst (0.15 %) and deQuervain surgery (0.25 %), and highest following cubital tunnel release (0.56 %) and trapeziometacarpal arthroplasty (0.49 %). Fifty-three percent of postoperative visits were treated in the emergency department setting, 37 % in the inpatient setting, and 10 % required an additional outpatient surgical procedure. Patients with government-funded insurance-Medicaid in particular-and those residing in rural areas had higher odds of postoperative acute care visits for surgical site infection. Diabetes, obesity, and tobacco use were not associated with increased risk for infection leading to an acute care visit.
  
  
  CONCLUSIONS
  The rates of postoperative acute care visits for surgical site infection after ambulatory hand procedures are low but not negligible-particularly given how common hand surgery is, and the fact that many of these events entail hospitalizations or additional ambulatory procedures. Reasons for the increased risk of acute care visits for infection among publicly insured and rural patients merit additional research.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 2100, Boston, MA, 02114, USA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.affiliation: Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA, USA.|Rheumatology Allergy and Immunology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.affiliation: Rheumatology Allergy and Immunology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Unizony
authors.affiliation: Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA, USA.|Rheumatology Allergy and Immunology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 2100, Boston, MA, 02114, USA. dring@partners.org.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D034941:Upper Extremity / Q000601:surgery
keywords: Complication; Hand surgery; Patient safety; Quality improvement; Surgical site infection