Delayed Elective Surgery Increased Postop Infection Rate

Major Finding: The postsurgical infection rate for patients who had surgery on the day they were admitted was 5.7% in CABG patients vs. 18.2% in those who waited 6-10 days. The corresponding rates were 8.4% vs. 21.6% in lung resection patients, and 10.2% vs. 20.6% in colon resection patients.

Data Source: Retrospective study of 163,000 elective-surgery patients from the Nationwide Inpatient Sample during 2003-2007.

Disclosures: Dr. Vogel reported no disclosures.

LAS VEGAS — The longer elective-surgery patients were hospitalized before their operation, the greater their risk of developing an infection postoperatively, according to a review of 163,000 patients.

Elective-admission patients hospitalized for just 1 day before their surgery had a significant 20%-50% increased risk of subsequent infection, compared with patients whose surgery took place the same day as their hospital admission, Dr. Todd R. Vogel reported.

Patients hospitalized for 6-10 days before surgery had a greater than twofold increased risk, said Dr. Vogel, a vascular surgeon at the Robert Wood Johnson Medical School, New Brunswick, N.J.

The data suggest it would be better to send patients home to await the day of their planned surgery than to keep them in the hospital until their slot on the schedule opens, he added.

Another possible explanation is that many of the delayed cases weren't really elective. “I think there were reasons for the delay that you can't pick out of your administrative database,” said Dr. E. Patchen Dellinger, professor and chief of the division of general surgery at the University of Washington, Seattle.

But Dr. Vogel pointed out that hospitals would want to “upcode” cases that were not elective because they would be paid more.

He and his associates used data collected during 2003-2007 in the Nationwide Inpatient Sample on elective admissions for three types of surgery: 87,318 for CABG, 46,728 for colon resection, and 28,960 for lung resection. Patients were aged 50-79 years. Nearly two-thirds were men, and 84% were white. The infectious complications analyzed included pneumonia, urinary tract infection, sepsis, and surgical site infections.

Patients undergoing CABG had the highest rate of delays between admission and surgery, with 53% having their surgery on the same day of admission, compared with 79% of colon resection patients and 94% of lung resection patients. Another 23% of the CABG patients had a 1-day delay, 21% had a 2-5 day delay, and 3% had their surgery 6-10 days after admission. In the colon resection group, 13% had a 1-day delay, 7% waited 2-5 days, and 2% waited 6-10 days. Among those having lung resection, 3% waited 1 day, 2% waited 2-5 days, and 1% waited 6-10 days.

The postsurgical infection rate for patients who had surgery on the day they were admitted was 5.7% in the CABG patients, 8.4% in the lung resection patients, and 10.2% in the colon resection patients. The rates increased for each incremental delay. Among patients whose surgery was performed 6-10 days after admission, postsurgical infection rates were 18.2% for CABG, 21.6% for lung resection, and 20.6% for colon resection.

Adjusted multivariate analysis showed that all delay durations led to significantly greater infection rates relative to no delay, for all three operations analyzed. (See box.)

Analysis further documented that in-hospital delays before surgery were linked to higher hospital costs, Dr. Vogel said.

Vitals

Source Elsevier Global Medical News

Major Finding: The postsurgical infection rate for patients who had surgery on the day they were admitted was 5.7% in CABG patients vs. 18.2% in those who waited 6-10 days. The corresponding rates were 8.4% vs. 21.6% in lung resection patients, and 10.2% vs. 20.6% in colon resection patients.

Data Source: Retrospective study of 163,000 elective-surgery patients from the Nationwide Inpatient Sample during 2003-2007.

Disclosures: Dr. Vogel reported no disclosures.

LAS VEGAS — The longer elective-surgery patients were hospitalized before their operation, the greater their risk of developing an infection postoperatively, according to a review of 163,000 patients.

Elective-admission patients hospitalized for just 1 day before their surgery had a significant 20%-50% increased risk of subsequent infection, compared with patients whose surgery took place the same day as their hospital admission, Dr. Todd R. Vogel reported.

Patients hospitalized for 6-10 days before surgery had a greater than twofold increased risk, said Dr. Vogel, a vascular surgeon at the Robert Wood Johnson Medical School, New Brunswick, N.J.

The data suggest it would be better to send patients home to await the day of their planned surgery than to keep them in the hospital until their slot on the schedule opens, he added.

Another possible explanation is that many of the delayed cases weren't really elective. “I think there were reasons for the delay that you can't pick out of your administrative database,” said Dr. E. Patchen Dellinger, professor and chief of the division of general surgery at the University of Washington, Seattle.

But Dr. Vogel pointed out that hospitals would want to “upcode” cases that were not elective because they would be paid more.

He and his associates used data collected during 2003-2007 in the Nationwide Inpatient Sample on elective admissions for three types of surgery: 87,318 for CABG, 46,728 for colon resection, and 28,960 for lung resection. Patients were aged 50-79 years. Nearly two-thirds were men, and 84% were white. The infectious complications analyzed included pneumonia, urinary tract infection, sepsis, and surgical site infections.

Patients undergoing CABG had the highest rate of delays between admission and surgery, with 53% having their surgery on the same day of admission, compared with 79% of colon resection patients and 94% of lung resection patients. Another 23% of the CABG patients had a 1-day delay, 21% had a 2-5 day delay, and 3% had their surgery 6-10 days after admission. In the colon resection group, 13% had a 1-day delay, 7% waited 2-5 days, and 2% waited 6-10 days. Among those having lung resection, 3% waited 1 day, 2% waited 2-5 days, and 1% waited 6-10 days.

The postsurgical infection rate for patients who had surgery on the day they were admitted was 5.7% in the CABG patients, 8.4% in the lung resection patients, and 10.2% in the colon resection patients. The rates increased for each incremental delay. Among patients whose surgery was performed 6-10 days after admission, postsurgical infection rates were 18.2% for CABG, 21.6% for lung resection, and 20.6% for colon resection.

Adjusted multivariate analysis showed that all delay durations led to significantly greater infection rates relative to no delay, for all three operations analyzed. (See box.)

Analysis further documented that in-hospital delays before surgery were linked to higher hospital costs, Dr. Vogel said.

Vitals

Source Elsevier Global Medical News

Major Finding: The postsurgical infection rate for patients who had surgery on the day they were admitted was 5.7% in CABG patients vs. 18.2% in those who waited 6-10 days. The corresponding rates were 8.4% vs. 21.6% in lung resection patients, and 10.2% vs. 20.6% in colon resection patients.

Data Source: Retrospective study of 163,000 elective-surgery patients from the Nationwide Inpatient Sample during 2003-2007.

Disclosures: Dr. Vogel reported no disclosures.

LAS VEGAS — The longer elective-surgery patients were hospitalized before their operation, the greater their risk of developing an infection postoperatively, according to a review of 163,000 patients.

Elective-admission patients hospitalized for just 1 day before their surgery had a significant 20%-50% increased risk of subsequent infection, compared with patients whose surgery took place the same day as their hospital admission, Dr. Todd R. Vogel reported.

Patients hospitalized for 6-10 days before surgery had a greater than twofold increased risk, said Dr. Vogel, a vascular surgeon at the Robert Wood Johnson Medical School, New Brunswick, N.J.

The data suggest it would be better to send patients home to await the day of their planned surgery than to keep them in the hospital until their slot on the schedule opens, he added.

Another possible explanation is that many of the delayed cases weren't really elective. “I think there were reasons for the delay that you can't pick out of your administrative database,” said Dr. E. Patchen Dellinger, professor and chief of the division of general surgery at the University of Washington, Seattle.

But Dr. Vogel pointed out that hospitals would want to “upcode” cases that were not elective because they would be paid more.

He and his associates used data collected during 2003-2007 in the Nationwide Inpatient Sample on elective admissions for three types of surgery: 87,318 for CABG, 46,728 for colon resection, and 28,960 for lung resection. Patients were aged 50-79 years. Nearly two-thirds were men, and 84% were white. The infectious complications analyzed included pneumonia, urinary tract infection, sepsis, and surgical site infections.

Patients undergoing CABG had the highest rate of delays between admission and surgery, with 53% having their surgery on the same day of admission, compared with 79% of colon resection patients and 94% of lung resection patients. Another 23% of the CABG patients had a 1-day delay, 21% had a 2-5 day delay, and 3% had their surgery 6-10 days after admission. In the colon resection group, 13% had a 1-day delay, 7% waited 2-5 days, and 2% waited 6-10 days. Among those having lung resection, 3% waited 1 day, 2% waited 2-5 days, and 1% waited 6-10 days.

The postsurgical infection rate for patients who had surgery on the day they were admitted was 5.7% in the CABG patients, 8.4% in the lung resection patients, and 10.2% in the colon resection patients. The rates increased for each incremental delay. Among patients whose surgery was performed 6-10 days after admission, postsurgical infection rates were 18.2% for CABG, 21.6% for lung resection, and 20.6% for colon resection.

Adjusted multivariate analysis showed that all delay durations led to significantly greater infection rates relative to no delay, for all three operations analyzed. (See box.)

Analysis further documented that in-hospital delays before surgery were linked to higher hospital costs, Dr. Vogel said.

Vitals

Source Elsevier Global Medical News