HealthDay News — The risk for clinically significant infections after ambulatory surgery is relatively small, yet outpatient surgical procedures account for about one in five healthcare-associated infections, according to researchers.

This seeming contradiction can be explained by the high proportion of ambulatory surgical procedures relative to overall U.S. outpatient operations (63%) — meaning the absolute number of patients affected is actually large, Pamela L. Owens, PhD, from the Agency for Healthcare Research and Quality in Rockville, Md., and colleagues reported in the Journal of the American Medical Association.

“These serious infections merit quality improvement efforts to minimize their occurrence,” the researchers wrote.

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Owens and colleagues conducted a retrospective analysis of data from the 2010 Healthcare Cost and Utilization Project State Ambulatory Surgery and State Inpatient Databases for eight states — California, Florida, Georgia. Hawaii, Missouri, Nebraska, New York and Tennessee.

They then sought to assess the incidence of clinically significant surgical site infections following low- to moderate-risk ambulatory surgery by determining the rate of post-surgical acute care visits for surgical site infections 14 and 30 days after the initial procedure. The analysis included outcomes from 284,098 adults who underwent one of 12 common ambulatory surgical procedures — general orthopedic, neurosurgical, gynecologic, and urologic surgery.

The overall rate of visits for surgical site infections was 3.09 per 1,000 procedures after 14 days, and 4.48 per 1,000 procedures at 30 days, the researchers found.

Following ambulatory surgery, all-cause inpatient or outpatient postsurgical visits, including those for CS-SSIs, occurred in 19.99 and 33.62 per 1,000 ambulatory surgical procedures at 14 days and 30 days, respectively.

Most visits (63.7%) occurred within 14 days of the surgery, with treatment for these primarily in the inpatient setting (93.2%).

“Among patients in eight states undergoing ambulatory surgery, rates of postsurgical visits for clinically significant-surgical site infections were low relative to all causes; however, they may represent a substantial number of adverse outcomes in aggregate,” the researchers concluded.

Infection rates varied by procedure, the researchers noted. For instance, the rate after laparoscopic repairs of inguinal or femoral hernias was 0.27 per 1,000 at 14 days vs. 6.44 per 1,000 for vaginal hysterectomy.

Instituting earlier follow-up visits after surgery could improve infection rates, the researchers suggested.

“Earlier access to a clinician or member of the surgical team may help identify and treat these infections early and reduce overall morbidity,” they wrote.

Study limitations include a lack of generalizability of infection rates from the eight states to other regions of the United States.


  1. Owens PL. JAMA. 2014; 311(7): 709-716.