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外科中心(ASC)进行。 在美国，ASC手术占所有当天手术的40%以上；然而，几乎没有 目前正在进行监测，以确定与ASC程序相关的感染。有很少的 手术部位感染(SSI)和耐药生物感染的发生率的数据，例如 艰难梭菌，在国家一级的ASC程序后或从个别设施。在最近的疾控中心 在接受调查的ASC中，85%的人发现推荐做法存在调查缺陷，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。术后感染监测 门诊手术需要跨医疗保健提供者和设施的信息集成。与 ASCs的增殖必须开发可重复性的方法来准确地识别以下感染 外科手术通常在ASCs中进行，以确定感染的临床和经济影响， 并开发模型来预测个别患者的感染风险。为了实现这些目标，我们 建议使用不同地理位置的纵向医疗和药房索赔数据 美国商业保险人群：1)确定艰难梭菌感染和SSI的发病率， 包括耐甲氧西林金黄色葡萄球菌感染，保乳手术后， 腹股沟疝修补术和胆囊切除术是ASCs中常见的三种手术，2)确定设施-和 与SSI和艰难梭菌感染风险增加相关的患者水平因素，3)开发和验证风险 预测模型使用了患者层面的风险因素，考虑了特定类型的手术 程序，4)确定SSI和艰难梭菌感染的临床结果和可归因性成本。这些方法 我们开发的确定感染可以作为国家监测ASC相关的基础 感染。这项研究将为提高患者安全和改善预后提供重要的新信息 适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.