Surgical Site and Clostridium difficile Infections after Ambulatory Surgery

摘要 在美国，每年有超过1500万例外科手术在门诊手术中心（ASC）进行。 ASC手术占美国所有当天手术的40%以上;然而，实际上没有 目前进行监视以识别与ASC程序相关的感染。太少 手术部位感染（SSI）和抗生素耐药微生物感染的发生率数据，例如 艰难梭菌，在国家一级或来自个体设施的ASC程序后。在最近的CDC 在85%的被调查ASC中发现了推荐做法的调查缺陷，其中大多数涉及 感染控制有必要对与ASCs相关的感染进行研究。感染后监测 门诊手术需要在医疗保健提供者和设施之间集成信息。与 ASCs的增殖，必须开发可重复的方法来准确地识别以下感染 通常在ASC中进行的外科手术以确定感染的临床和经济影响， 并开发模型来预测个体患者的感染风险。为了实现这些目标，我们 建议使用来自世界上最大的 美国商业保险人群：1）确定C.艰难梭菌感染和SSI， 包括由耐甲氧西林金黄色葡萄球菌引起的感染，在保乳手术后， 疝修补术和胆囊切除术，在ASC中进行的三种常见手术，2）确定设施， 与SSI和C.艰难梭菌感染，3）开发和验证风险 使用患者水平风险因素的预测模型，同时考虑到特定类型的手术 4）确定SSI和C.艰难感染的方法 我们开发的识别感染的方法可以作为国家监测ASC相关疾病的基础。 感染.这项研究将提供重要的新信息，以提高患者的安全性和改善结果 用于在门诊环境中接受普通外科手术的患者。

Abstract Over 15 million surgical procedures are performed in ambulatory surgical centers (ASCs) in the U.S. annually. ASC procedures account for more than 40% of all same-day surgeries in the U.S.; however, virtually no surveillance is currently performed to identify infections associated with ASC procedures. There are very little data on the incidence of surgical site infection (SSI) and infection with antibiotic resistant organisms, such as Clostridium difficile, after ASC procedures at the national level or from individual facilities. In a recent CDC survey deficiencies in recommended practices were found in 85% of surveyed ASCs, most of which involved infection control. There is a need for research on infections associated with ASCs. Infection surveillance after ambulatory surgeries requires integration of information across healthcare providers and facilities. With the proliferation of ASCs it is essential to develop reproducible methods to accurately identify infections following surgical procedures commonly performed in ASCs to determine the clinical and economic impact of infection, and to develop models to predict the risk of infection in individual patients. To accomplish these goals we propose to use geographically diverse longitudinal medical and pharmacy claims data from the largest commercially insured population in the U.S. to: 1) determine the incidence of C. difficile infection and SSIs, including infections caused by methicillin-resistant Staphylococcus aureus, after breast conserving surgery, hernia repair, and cholecystectomy, three common procedures performed in ASCs, 2) identify facility- and patient-level factors associated with increased risk of SSI and C. difficile infection, 3) develop and validate risk prediction models using the patient-level risk factors, taking into account the specific types of surgical procedures, 4) determine clinical outcomes and attributable costs of SSI and C. difficile infection. The methods we develop to identify infections can be used as the basis for national surveillance of ASC-associated infections. This study will provide significant new information to enhance patient safety and improve outcomes for patients undergoing common surgical procedures in ambulatory settings.