World Journal of Surgery

, Volume 42, Issue 12, pp 3888–3896 | Cite as

Associations of Hospital Length of Stay with Surgical Site Infections

  • Edin Mujagic
  • Walter R. Marti
  • Michael Coslovsky
  • Savas D. Soysal
  • Robert Mechera
  • Marco von Strauss
  • Jasmin Zeindler
  • Franziska Saxer
  • Alexandra Mueller
  • Christoph A. Fux
  • Christoph Kindler
  • Lorenz Gurke
  • Walter P. Weber
Original Scientific Report



Surgical site infections (SSI) are a major cause of morbidity and mortality in surgical patients. Postoperative and total hospital length of stay (LOS) are known to be prolonged by the occurrence of SSI. Preoperative LOS may increase the risk of SSI. This study aims at identifying the associations of pre- and postoperative LOS in hospital and intensive care with the occurrence of SSI.


This observational cohort study includes general, orthopedic trauma and vascular surgery patients at two tertiary referral centers in Switzerland between February 2013 and August 2015. The outcome of interest was the 30-day SSI rate.


We included 4596 patients, 234 of whom (5.1%) experienced SSI. Being admitted at least 1 day before surgery compared to same-day surgery was associated with a significant increase in the odds of SSI in univariate analysis (OR 1.65, 95% CI 1.25–2.21, p < 0.001). More than 1 day compared to 1 day of preoperative hospital stay did not further increase the odds of SSI (OR 1.08, 95% CI 0.77–1.50, p = 0.658). Preoperative admission to an intensive care unit (ICU) increased the odds of SSI as compared to hospital admission outside of an ICU (OR 2.19, 95% CI 0.89–4.59, p = 0.057). Adjusting for potential confounders in multivariable analysis weakened the effects of both preoperative admission to hospital (OR 1.38, 95% CI 0.99–1.93, p = 0.061) and to the ICU (OR 1.89, 95% CI 0.73–4.24, p = 0.149).


There was no significant independent association between preoperative length of stay and risk of SSI while SSI and postoperative LOS were significantly associated.



This work was financially supported by the Swiss National Foundation, the “Kantonsspital Aarau”, the “Gottfried und Julia Bangerter-Rhyner-Stiftung”, the University of Basel, the “Freiwillige Akademische Gesellschaft Basel”, and the “Nora van Meeuwen-Haefliger-Stiftung”.

Compliance with ethical standards

Conflict of interest

None of the authors has any potential or real conflicts of interest to report.


  1. 1.
    Lewis SS, Moehring RW, Chen LF et al (2013) Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol 34:1229–1230CrossRefGoogle Scholar
  2. 2.
    Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278 (quiz 279–280) CrossRefGoogle Scholar
  3. 3.
    Coskun D, Aytac J, Aydinli A et al (2005) Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey. J Hosp Infect 60:176–179CrossRefGoogle Scholar
  4. 4.
    Coello R, Charlett A, Wilson J et al (2005) Adverse impact of surgical site infections in English hospitals. J Hosp Infect 60:93–103CrossRefGoogle Scholar
  5. 5.
    Kirkland KB, Briggs JP, Trivette SL et al (1999) The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 20:725–730CrossRefGoogle Scholar
  6. 6.
    Poulsen KB, Bremmelgaard A, Sorensen AI et al (1994) Estimated costs of postoperative wound infections. A case-control study of marginal hospital and social security costs. Epidemiol Infect 113:283–295CrossRefGoogle Scholar
  7. 7.
    Vegas AA, Jodra VM, Garcia ML (1993) Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 9:504–510PubMedGoogle Scholar
  8. 8.
    Boyce JM, Potter-Bynoe G, Dziobek L (1990) Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol 11:89–93CrossRefGoogle Scholar
  9. 9.
    Hollenbeak CS, Murphy DM, Koenig S et al (2000) The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 118:397–402CrossRefGoogle Scholar
  10. 10.
    Jenney AW, Harrington GA, Russo PL et al (2001) Cost of surgical site infections following coronary artery bypass surgery. ANZ J Surg 71:662–664CrossRefGoogle Scholar
  11. 11.
    McGarry SA, Engemann JJ, Schmader K et al (2004) Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost. Infect Control Hosp Epidemiol 25:461–467CrossRefGoogle Scholar
  12. 12.
    Ortona L, Federico G, Fantoni M et al (1987) A study on the incidence of postoperative infections and surgical sepsis in a university hospital. Infect. Control 8:320–324CrossRefGoogle Scholar
  13. 13.
    Weber WP, Zwahlen M, Reck S et al (2008) Economic burden of surgical site infections at a European university hospital. Infect Control Hosp Epidemiol 29:623–629CrossRefGoogle Scholar
  14. 14.
    Whitehouse JD, Friedman ND, Kirkland KB et al (2002) The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 23:183–189CrossRefGoogle Scholar
  15. 15.
    Bueno Cavanillas A, Rodriguez-Contreras R, Delgado Rodriguez M et al (1991) Preoperative stay as a risk factor for nosocomial infection. Eur J Epidemiol 7:670–676CrossRefGoogle Scholar
  16. 16.
    deFreitas DJ, Kasirajan K, Ricotta JJ 2nd et al (2012) Preoperative inpatient hospitalization and risk of perioperative infection following elective vascular procedures. Ann Vasc Surg 26:46–54PubMedGoogle Scholar
  17. 17.
    Pereira HO, Rezende EM, Couto BR et al (2015) Length of preoperative hospital stay: a risk factor for reducing surgical infection in femoral fracture cases. Revista brasileira de ortopedia 50:638–646CrossRefGoogle Scholar
  18. 18.
    Vogel TR, Dombrovskiy VY, Lowry SF et al (2010) In-hospital delay of elective surgery for high volume procedures: the impact on infectious complications. J Am Coll Surg 211:784–790CrossRefGoogle Scholar
  19. 19.
    Pathak A, Saliba EA, Sharma S et al (2014) Incidence and factors associated with surgical site infections in a teaching hospital in Ujjain, India. Am J Infect Control 42:11–15CrossRefGoogle Scholar
  20. 20.
    Blonna D, Barbasetti di Prun N, Bellato E et al (2016) Effect of surgical delay on bacterial colonization in proximal humeral fractures. J Orthop Res 34:942–948CrossRefGoogle Scholar
  21. 21.
    Cordero J, Maldonado A, Iborra S (2016) Surgical delay as a risk factor for wound infection after a hip fracture. Injury 47(S3):S56–S60CrossRefGoogle Scholar
  22. 22.
    Weber WP, Mujagic E, Zwahlen M et al (2017) Timing of surgical antimicrobial prophylaxis: a phase 3 randomised controlled trial. Lancet Infect Dis. 17:605–614CrossRefGoogle Scholar
  23. 23.
    Mujagic E, Zwimpfer T, Marti WR et al (2014) Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial. Trials 15:188CrossRefGoogle Scholar
  24. 24.
    Rodriguez-Acelas AL, de Abreu Almeida M, Engelman B et al (2017) Risk factors for health care-associated infection in hospitalized adults: systematic review and meta-analysis. Am J Infect Control 45:e149–e156CrossRefGoogle Scholar
  25. 25.
    Misteli H, Widmer AF, Rosenthal R et al (2011) Spectrum of pathogens in surgical site infections at a Swiss university hospital. Swiss Med Wkly 20:w13146Google Scholar
  26. 26.
    Anderson DJ, Sexton DJ, Kanafani ZA et al (2007) Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 28:1047–1053CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Edin Mujagic
    • 1
  • Walter R. Marti
    • 2
  • Michael Coslovsky
    • 3
  • Savas D. Soysal
    • 1
  • Robert Mechera
    • 1
  • Marco von Strauss
    • 2
  • Jasmin Zeindler
    • 1
  • Franziska Saxer
    • 4
  • Alexandra Mueller
    • 2
  • Christoph A. Fux
    • 5
  • Christoph Kindler
    • 6
  • Lorenz Gurke
    • 1
  • Walter P. Weber
    • 1
  1. 1.Department of SurgeryUniversity of Basel and University Hospital BaselBaselSwitzerland
  2. 2.Department of SurgeryKantonsspital AarauAarauSwitzerland
  3. 3.Clinical Trial UnitUniversity of Basel and University Hospital BaselBaselSwitzerland
  4. 4.Department of Orthopedic Trauma SurgeryUniversity of Basel and University Hospital BaselBaselSwitzerland
  5. 5.Department of Infectious Diseases and Hospital HygieneKantonsspital AarauAarauSwitzerland
  6. 6.Department of AnesthesiologyKantonsspital AarauAarauSwitzerland

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