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Inpatient Status Drives Risk of Superficial Surgical Site Infection In Tendon Procedures
P. Sanati-Mehrizy, BA; J. Hernandez-Rosa, MD; PJ Taub, MD
Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Post-operative superficial surgical site infections (SSSI) have been show to increase morbidity while lengthening hospital stay and increasing hospital cost 1 This study aims to identify risk factors implicated in surgical site infections in hand surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) was queried based on CPT code for patients who underwent hand surgery from 2005 through 2012. Cases identified were stratified into the following categories: "All Cases," "Fractures and Dislocations," and "Tendon Procedures." Univariate analysis was performed to identify the association between SSSI and potential demographic and medical risk factors, including: inpatient/outpatient status, surgical specialty, diabetes, smoking, alcohol use, hypertension, and intraoperative transfusion. Multivariate analysis was performed assessing the above risk factors as potential confounders.
Results: 2056 cases of hand surgery were identified and met inclusion criteria, which were further classified into the following subsets: "Fracture and Dislocations" (n=1129) and "Tendon cases" (n=927). Incidence for SSSI was largest in the "Tendon procedures" subset of cases (Table 1). Further analysis was performed on this subset to identify risk factors for SSSI. Univariate analysis for risk factors associated with SSSI identified a significant association with inpatient status (vs. outpatient) and surgery performed by a Plastic Surgeon (vs. Orthopedic Surgeon). Multivariate logistic regression indicated that surgical specialty, as a risk factor, is not statistically significant when controlled for inpatient/outpatient status. Rather, inpatient/outpatient status is an independent risk factor when controlling for specialty as well as for age, gender, race, smoking, diabetes, previous cardiac surgery, hypertension, steroid use, and emergency case status (Table 2). Of note, tendon procedures performed on inpatients were significantly more likely to be conducted by plastic surgeons than by orthopedic surgeons (Table 3).

Conclusion: Inpatient status was identified as an independent risk factor for SSSI among hand tendon surgeries. While univariate analysis identifies surgical specialty as a risk factor, this difference is attributed to a significantly increased rate of inpatient hand surgeries performed by Plastic Surgeons.

1. Vegas AA, Jodra VM, Garc'a ML. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 1993; 9:504.

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