Surgical site infection in hand surgery

Abstract

Purpose

As ambulatory surgery becomes increasingly common, there is growing interest in assessing, monitoring, and tracking complications that occur secondary to outpatient procedures. We sought to determine the rates of 14- and 30-day acute care visits for surgical site infection after outpatient hand surgery, and to identify associated factors.

Methods

Using the California State Ambulatory Surgery database for 2010 and 2011, we identified 44,305 patients undergoing common outpatient hand surgery procedures. Cases were linked to the State Emergency Department and the State Inpatient databases for postoperative acute care visits (e.g. hospitalizations, emergency department or ambulatory surgical visits) related to surgical site infection.

Results

Postoperative acute care visits for surgical site infection occurred in 1.7 per 1,000 hand surgery procedures (0.17 %) at 14 days, and 3.3 per 1,000 (0.33 %) at 30 days. Thirty-day infection rates were lowest after ganglion cyst (0.15 %) and deQuervain surgery (0.25 %), and highest following cubital tunnel release (0.56 %) and trapeziometacarpal arthroplasty (0.49 %). Fifty-three percent of postoperative visits were treated in the emergency department setting, 37 % in the inpatient setting, and 10 % required an additional outpatient surgical procedure. Patients with government-funded insurance—Medicaid in particular—and those residing in rural areas had higher odds of postoperative acute care visits for surgical site infection. Diabetes, obesity, and tobacco use were not associated with increased risk for infection leading to an acute care visit.

Conclusion

The rates of postoperative acute care visits for surgical site infection after ambulatory hand procedures are low but not negligible—particularly given how common hand surgery is, and the fact that many of these events entail hospitalizations or additional ambulatory procedures. Reasons for the increased risk of acute care visits for infection among publicly insured and rural patients merit additional research.

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Correspondence to David Ring.

Additional information

Level of evidence: Level III, Prognostic study

Appendix 1. Coding definitions for SSIs

Appendix 1. Coding definitions for SSIs

ICD-9-CM Diagnosis codes

686.0: Pyoderma

686.00: Pyoderma, unspecified

686.09: Other pyoderma

686.1: Pyogenic granuloma of skin and subcutaneous tissue

686.8: Other specified local infections of skin and subcutaneous tissue

998.5: Postoperative infection, not elsewhere classified

998.51: Infected postoperative seroma

998.59: Other postoperative infection

682.3: Cellulitis of arm

682.4: Cellulitis of hand

711.03: Pyogenic arthritis, forearm

711.63: Arthropathy associated with mycoses, forearm

711.64: Arthropathy associated with mycoses, hand

730.03: Acute osteomyelitis of forearm

730.04: Acute osteomyelitis of hand

730.23: Unspecified osteomyelitis of forearm

730.24: Unspecified osteomyelitis of hand

730.93: Unspecified infection of bone, forearm

730.94: Unspecified infection of bone, hand

CPT Procedure codes

10060: Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single

10061: Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple

10180: Incision and drainage, complex, postoperative wound infection

11000: Debridement of extensive eczematous or infected skin; up to 10% of body surface

11001: Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof

20000: Incision of soft tissue abscess; superficial (musculoskeletal system)

20005: Incision of soft tissue abscess; deep or complicated (musculoskeletal system)

ICD-9-CM Procedure codes

86.04: Other incision with drainage of skin and subcutaneous tissue

86.22: Excisional debridement of wound, infection, or burn

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Menendez, M.E., Lu, N., Unizony, S. et al. Surgical site infection in hand surgery. International Orthopaedics (SICOT) 39, 2191–2198 (2015). https://doi.org/10.1007/s00264-015-2849-9

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Keywords

  • Surgical site infection
  • Hand surgery
  • Complication
  • Patient safety
  • Quality improvement