Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration

M B Koek; J C Wille; M R Isken; A Voss; B H van Benthem

doi:10.2807/1560-7917.ES2015.20.8.21042

Surveillance and outbreak reports Open Access

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Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration

M B Koek¹, J C Wille¹, M R Isken², A Voss^2,3, B H van Benthem¹
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Affiliations: ¹ Department of Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands ² Medical Microbiology & Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands ³ Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

Correspondence:
M Koek
mayke.koek rivm.nl
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Citation style for this article: Koek M B, Wille J C, Isken M R, Voss A, van Benthem B H. Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration. Euro Surveill. 2015;20(8):pii=21042. https://doi.org/10.2807/1560-7917.ES2015.20.8.21042 Received: 18 Aug 2014; Accepted:

Abstract

Post-discharge surveillance (PDS) for surgical site infections (SSIs) normally lasts 30 days, or one year after implant surgery, causing delayed feedback to healthcare professionals. We investigated the effect of shortened PDS durations on SSI incidence to determine whether shorter PDS durations are justified. We also studied the impact of two national PDS methods (those mandatory since 2009 ('mandatory') and other methods acceptable before 2009 ('other')) on SSI incidence. From Dutch surveillance (PREZIES) data (1999-2008), four implant-free surgeries (breast amputation, Caesarean section, laparoscopic cholecystectomy and colectomy) and two implant surgeries (knee replacement and total hip replacement) were selected . We studied the impact of PDS duration and method on SSI incidences by survival and Cox regression analyses. We included 105,607 operations. Shortened PDS duration for implant surgery from one year to 90 days resulted in 6-14% of all SSIs being missed. For implant-free procedures, PDS reduction from 30 to 21 days caused similar levels of missed SSIs. In contrast, up to 62% of SSIs (for cholecystectomy) were missed if other instead of mandatory PDS methods were used. Inferior methods of PDS, rather than shortened PDS durations, may lead to greater underestimation of SSI incidence. Our data validate international recommendations to limit the maximum PDS duration (for implant surgeries) to 90 days for surveillance purposes, as this provides robust insight into trends. .