>>For Doctors >>August 2013

Surgical Site Infections:
Triple the Mortality Rate among Elderly Patients

A study published recently in the Journal of the American Geriatrics Society examined the effects of surgical site infections (SSI) on patients age 65+.1  Dr. Kaye and colleagues performed a retrospective, matched outcome study with 1,337 subjects.  Tracking results for only 90 days post-surgery, they found that SSI triples the mortality rate (15.3% vs. 5.2%), increases hospital expenses by an average of $41,124, and increases the rate of hospital re-admission by more than 400%.  The authors conclude that because outcomes attributable to SSI are severe, proactive management of SSI is particularly important among elderly patients.

The current trend is to take all measures to prevent SSI in surgery and in facility.  Patients are then sent home with healing wounds and with patient/family implemented wound care instructions.  Consequently, most surgical site infections manifest in the home environment, but the exact extent to which home-acquired infections contribute to the prevalence of SSI is unkown.2-5  Having drains in place increases the likelihood that an SSI can be acquired in the home, and it is known that at least some healthcare-related infections are introduced in the home environment.5     

The literature often comments that physicians and hospitals have no control over post-discharge variables.   This observation should be qualified by the fact that many elderly patients at risk of SSI will qualify for home health services designed to prevent home-acquired infections, ensure adherence to post-surgical instructions, teach family caregivers, monitor SSI, manage SSI in the home, and/or prevent unnecessary re-hospitalization.  There are additional risk factors that would further suggest the appropriateness of a referral to Ideal Home Care.  While being age 65+ in itself ranks as a significant risk factor for SSI, additional risk factors include poor post-operative glycemic control, obesity, diabetes mellitus, malnutrition, prolonged inpatient stay, infection at a remote site, immunosuppressive drugs, and duration of surgery.6  

When these patients are homebound, even temporarily due to surgery, home health is often appropriate.  Ideal Home Care nurses can provide wound care including certified negative pressure wound therapy, patient and family teaching, skilled wound monitoring, nutritional intervention, assistance with glycemic control, and more.  Promptly identifying and managing SSI in the less costly home environment can serve as a major cost saver for patient and payor while also protecting patient safety.

 

References

1. Kaye K, Anderson D, Sloane R, et al. The effect of surgical site infection on older operative patients. J Am Geriatr Soc. 2009; 57(1): 46-54.
2. Barnes S, Salemi C, Fithian D. An enhanced benchmark for prosthetic joint replacement rates. American Journal of Infection Control. 2006; 34 (10): 669-672.
3. Avato J, Lai K. Impact of postdischarge surveillance on surgical-site infection rates for coronary artery bypass procedures.  Infection Control and Hospital Epidemiology. 2002; 23 (7): 364-367.
4. Sands K, Vineyard G, Platt R. Surgical site infections occurring after hospital discharge. J Infect Dis. 1996; 173: 963-70.
5. Manangan L, Pearson M, Tokars J, et al. Feasibility of national surveillance of health-care-associated infections in home-care settings. Emerging Infectious Diseases. 2002; 8 (3): 233-236.
6. Mangram AJ, Horan TC, Pearson ML, et al. The Hospital Infection Control Practices Advisory Committee. Guideline for the prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999; 20: 247-280.